- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $407.38 / $912.01
| Professional | | $281.84 | $407.38 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $446.68 / $630.96
| Professional | | $85.11 | $446.68 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $512.86 / $933.25
| Professional | | $239.88 | $512.86 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $524.81 / $1,047.13
| Professional | | $316.23 | $524.81 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $512.86 / $776.25
| Professional | | $251.19 | $512.86 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $660.69 / $933.25
| Professional | | $323.59 | $660.69 | $933.25 |