- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $354.81 / $758.58
| Professional | | $269.15 | $354.81 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $501.19 / $691.83
| Professional | | $363.08 | $501.19 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $426.58 / $645.65
| Professional | | $288.40 | $426.58 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $524.81 / $1,258.93
| Professional | | $331.13 | $524.81 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $380.19 / $478.63
| Professional | | $363.08 | $380.19 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $426.58
| Professional | | $32.36 | $33.11 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $363.08 / $630.96
| Professional | | $269.15 | $363.08 | $630.96 |