- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.15 / $193.15 / $477.83
| Professional | | $135.15 | $193.15 | $477.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.51 / $451.88 / $645.67
| Professional | | $328.51 | $451.88 | $645.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.85 / $504.84 / $1,679.12
| Professional | | $221.85 | $504.84 | $1,679.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.46 / $417.42 / $570.47
| Professional | | $328.46 | $417.42 | $570.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.68 / $312.45 / $437.95
| Professional | | $224.68 | $312.45 | $437.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.56 / $430.10 / $624.90
| Professional | | $236.56 | $430.10 | $624.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.00 / $379.30 / $531.60
| Professional | | $310.00 | $379.30 | $531.60 |