- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.13 / $382.35 / $498.82
| Professional | | $290.13 | $382.35 | $498.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.36 / $331.00 / $471.42
| Professional | | $248.36 | $331.00 | $471.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.55 / $455.77 / $651.10
| Professional | | $290.55 | $455.77 | $651.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.22 / $425.38 / $865.47
| Professional | | $309.22 | $425.38 | $865.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $550.07
| Professional | | $32.34 | $32.34 | $550.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.44 / $481.05 / $761.93
| Professional | | $368.44 | $481.05 | $761.93 |