- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.18 / $343.18 / $347.82
| Professional | | $343.18 | $343.18 | $347.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.91 / $371.01 / $504.57
| Professional | | $333.91 | $371.01 | $504.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.17 / $533.17 / $666.48
| Professional | | $533.17 | $533.17 | $666.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.76 / $533.32 / $695.64
| Professional | | $463.76 | $533.32 | $695.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.78 / $217.97 / $422.01
| Professional | | $194.78 | $217.97 | $422.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $2.58 / $2.61
| Professional | | $2.04 | $2.58 | $2.61 |