- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $398.11 / $575.44
| Professional | | $288.40 | $398.11 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $42.66 / $48.98
| Professional | | $36.31 | $42.66 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $346.74
| Professional | | $281.84 | $281.84 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Professional | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $398.11 / $575.44
| Professional | | $288.40 | $398.11 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $85.11 / $758.58
| Professional | | $77.62 | $85.11 | $758.58 |