- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.36 / $403.52 / $680.82
| Professional | | $306.36 | $403.52 | $680.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.74 / $554.62 / $791.52
| Professional | | $419.74 | $554.62 | $791.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.13 / $530.26 / $849.93
| Professional | | $306.13 | $530.26 | $849.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.45 / $660.26 / $1,122.52
| Professional | | $374.45 | $660.26 | $1,122.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.64 / $442.53 / $635.13
| Professional | | $432.64 | $442.53 | $635.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $732.84
| Professional | | $32.34 | $32.34 | $732.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.62 / $590.71 / $1,057.31
| Professional | | $420.62 | $590.71 | $1,057.31 |