- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.43 / $270.94 / $356.78
| Professional | | $182.43 | $270.94 | $356.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.38 / $33.50 / $33.50
| Professional | | $30.38 | $33.50 | $33.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.22 / $354.68 / $614.05
| Professional | | $343.22 | $354.68 | $614.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $200.00
| Professional | | $100.00 | $100.00 | $200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.50 / $287.38 / $458.01
| Professional | | $237.50 | $287.38 | $458.01 |