- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.36 / $331.38 / $552.22
| Professional | | $260.36 | $331.38 | $552.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.18 / $449.26 / $571.75
| Professional | | $254.18 | $449.26 | $571.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.85 / $363.41 / $478.72
| Professional | | $272.85 | $363.41 | $478.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.27 / $302.27 / $302.27
| Professional | | $302.27 | $302.27 | $302.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.53 / $284.25 / $422.52
| Professional | | $29.53 | $284.25 | $422.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.17 / $343.46 / $850.63
| Professional | | $257.17 | $343.46 | $850.63 |