- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.38 / $295.70 / $390.82
| Professional | | $222.38 | $295.70 | $390.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.64 / $548.16 / $2,009.78
| Professional | | $332.64 | $548.16 | $2,009.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.32 / $194.32 / $194.32
| Professional | | $194.32 | $194.32 | $194.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.77 / $583.63 / $800.19
| Professional | | $299.77 | $583.63 | $800.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.99 / $370.29 / $629.92
| Professional | | $62.99 | $370.29 | $629.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.04 / $541.76 / $648.41
| Professional | | $367.04 | $541.76 | $648.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.64 / $468.00 / $619.76
| Professional | | $332.64 | $468.00 | $619.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.65 / $336.99 / $649.14
| Professional | | $213.65 | $336.99 | $649.14 |