- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.63 / $402.01 / $508.83
| Professional | | $329.63 | $402.01 | $508.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.25 / $294.76 / $512.20
| Professional | | $243.25 | $294.76 | $512.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.41 / $432.97 / $748.04
| Professional | | $365.41 | $432.97 | $748.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.97 / $496.40 / $890.36
| Professional | | $313.97 | $496.40 | $890.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.89 / $557.10 / $855.32
| Professional | | $390.89 | $557.10 | $855.32 |