- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.74 / $159.41 / $729.86
| Professional | | $95.74 | $159.41 | $729.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.10 / $135.10 / $135.10
| Professional | | $135.10 | $135.10 | $135.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.20 / $357.85 / $420.18
| Professional | | $310.20 | $357.85 | $420.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.99 / $342.86 / $481.67
| Professional | | $256.99 | $342.86 | $481.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.10 / $342.16 / $464.35
| Professional | | $135.10 | $342.16 | $464.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.49 / $379.07 / $449.98
| Professional | | $260.49 | $379.07 | $449.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.09 / $384.85 / $501.27
| Professional | | $189.09 | $384.85 | $501.27 |