- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.24 / $552.91 / $552.92
| Professional | | $237.24 | $552.91 | $552.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.53 / $595.67 / $852.69
| Professional | | $541.53 | $595.67 | $852.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.81 / $638.99 / $963.20
| Professional | | $350.81 | $638.99 | $963.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.68 / $640.98 / $983.29
| Professional | | $497.68 | $640.98 | $983.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.59 / $552.91 / $825.80
| Professional | | $253.59 | $552.91 | $825.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.03 / $440.50 / $886.50
| Professional | | $333.03 | $440.50 | $886.50 |