- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.09 / $214.81 / $710.30
| Professional | | $125.09 | $214.81 | $710.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.43 / $251.22 / $429.07
| Professional | | $132.43 | $251.22 | $429.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.83 / $428.93 / $706.62
| Professional | | $203.83 | $428.93 | $706.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.54 / $503.66 / $1,710.56
| Professional | | $286.54 | $503.66 | $1,710.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.49 / $406.70 / $619.71
| Professional | | $281.49 | $406.70 | $619.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.54 / $504.85 / $554.85
| Professional | | $286.54 | $504.85 | $554.85 |