- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.14 / $564.63 / $750.61
| Professional | | $393.14 | $564.63 | $750.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.41 / $344.64 / $542.78
| Professional | | $284.41 | $344.64 | $542.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.28 / $512.42 / $801.63
| Professional | | $356.28 | $512.42 | $801.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.67 / $576.74 / $1,845.96
| Professional | | $364.67 | $576.74 | $1,845.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $203.38
| Professional | | $32.34 | $32.34 | $203.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.76 / $605.53 / $1,134.45
| Professional | | $446.76 | $605.53 | $1,134.45 |