- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.69 / $289.06 / $399.09
| Professional | | $213.69 | $289.06 | $399.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.32 / $231.78 / $530.99
| Professional | | $57.32 | $231.78 | $530.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.10 / $313.39 / $551.91
| Professional | | $213.10 | $313.39 | $551.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.86 / $332.79 / $492.35
| Professional | | $283.86 | $332.79 | $492.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.64 / $192.46 / $333.39
| Professional | | $33.64 | $192.46 | $333.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.91 / $389.20 / $526.38
| Professional | | $318.91 | $389.20 | $526.38 |