- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.30 / $314.02 / $425.72
| Professional | | $227.30 | $314.02 | $425.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.74 / $331.31 / $393.83
| Professional | | $63.74 | $331.31 | $393.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.58 / $360.34 / $736.72
| Professional | | $242.58 | $360.34 | $736.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.08 / $359.77 / $501.48
| Professional | | $292.08 | $359.77 | $501.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.05 / $279.61 / $419.86
| Professional | | $32.05 | $279.61 | $419.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.47 / $458.36 / $604.46
| Professional | | $350.47 | $458.36 | $604.46 |