- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.52 / $605.54 / $605.54
| Professional | | $267.52 | $605.54 | $605.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.82 / $453.82 / $453.82
| Professional | | $453.82 | $453.82 | $453.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.15 / $373.15 / $745.50
| Professional | | $373.15 | $373.15 | $745.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.98 / $532.50 / $779.58
| Professional | | $231.98 | $532.50 | $779.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.82 / $473.75 / $690.05
| Professional | | $453.82 | $473.75 | $690.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.19 / $545.19 / $545.19
| Professional | | $545.19 | $545.19 | $545.19 |