- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.49 / $341.83 / $720.76
| Professional | | $255.49 | $341.83 | $720.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.14 / $341.54 / $464.25
| Professional | | $306.14 | $341.54 | $464.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.47 / $413.45 / $620.90
| Professional | | $257.47 | $413.45 | $620.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $352.04 / $593.12
| Professional | | $6.00 | $352.04 | $593.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.08 / $369.62 / $581.49
| Professional | | $4.08 | $369.62 | $581.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.48 / $426.54 / $700.57
| Professional | | $322.48 | $426.54 | $700.57 |