- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.36 / $323.37 / $605.82
| Professional | | $234.36 | $323.37 | $605.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.39 / $370.81 / $564.70
| Professional | | $266.39 | $370.81 | $564.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.54 / $204.94 / $286.26
| Professional | | $25.54 | $204.94 | $286.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.55 / $427.90 / $615.02
| Professional | | $291.55 | $427.90 | $615.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.05 / $385.91 / $732.96
| Professional | | $324.05 | $385.91 | $732.96 |