- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.70 / $311.48 / $429.51
| Professional | | $268.70 | $311.48 | $429.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.67 / $446.67 / $446.67
| Professional | | $446.67 | $446.67 | $446.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.68 / $442.84 / $442.84
| Professional | | $407.68 | $442.84 | $442.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.92 / $380.47 / $560.04
| Professional | | $300.92 | $380.47 | $560.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.64 / $369.30 / $473.39
| Professional | | $295.64 | $369.30 | $473.39 |