- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $436.52 / $758.58
| Professional | | $309.03 | $436.52 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $524.81 / $977.24
| Professional | | $331.13 | $524.81 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $309.03 / $436.52
| Professional | | $295.12 | $309.03 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $537.03
| Professional | | $32.36 | $33.11 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $478.63 / $831.76
| Professional | | $309.03 | $478.63 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $323.59 / $426.58
| Professional | | $263.03 | $323.59 | $426.58 |