- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.70 / $295.64 / $614.34
| Professional | | $264.70 | $295.64 | $614.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.74 / $417.55 / $503.52
| Professional | | $294.74 | $417.55 | $503.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.02 / $428.84 / $503.57
| Professional | | $404.02 | $428.84 | $503.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $172.85 / $390.01
| Professional | | $32.34 | $172.85 | $390.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.38 / $420.45 / $503.57
| Professional | | $357.38 | $420.45 | $503.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.20 / $352.00 / $508.20
| Professional | | $244.20 | $352.00 | $508.20 |