- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.67 / $420.42 / $681.36
| Professional | | $239.67 | $420.42 | $681.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.61 / $311.00 / $501.80
| Professional | | $217.61 | $311.00 | $501.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.26 / $384.28 / $594.52
| Professional | | $297.26 | $384.28 | $594.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $533.60
| Professional | | $32.34 | $32.34 | $533.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.49 / $398.66 / $631.17
| Professional | | $320.49 | $398.66 | $631.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.08 / $433.01 / $634.41
| Professional | | $329.08 | $433.01 | $634.41 |