- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.52 / $295.44 / $393.92
| Professional | | $166.52 | $295.44 | $393.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.91 / $547.76 / $547.76
| Professional | | $534.91 | $547.76 | $547.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.28 / $175.28 / $427.61
| Professional | | $175.28 | $175.28 | $427.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.57 / $395.77 / $630.00
| Professional | | $287.57 | $395.77 | $630.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.57 / $511.24 / $1,500.00
| Professional | | $123.57 | $511.24 | $1,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.63 / $182.18 / $322.58
| Professional | | $142.63 | $182.18 | $322.58 |