- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.67 / $405.82 / $544.96
| Professional | | $349.67 | $405.82 | $544.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.50 / $528.34 / $628.72
| Professional | | $475.50 | $528.34 | $628.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.12 / $550.69 / $1,058.88
| Professional | | $309.12 | $550.69 | $1,058.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.63 / $437.99 / $597.26
| Professional | | $298.63 | $437.99 | $597.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.00 / $121.46 / $166.01
| Professional | 26 | $83.00 | $121.46 | $166.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.11 / $376.94 / $730.70
| Professional | | $210.11 | $376.94 | $730.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.19 / $453.22 / $566.52
| Professional | | $361.19 | $453.22 | $566.52 |