- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.06 / $378.76 / $475.59
| Professional | | $223.06 | $378.76 | $475.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.79 / $273.20 / $433.94
| Professional | | $199.79 | $273.20 | $433.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.42 / $350.51 / $584.94
| Professional | | $226.42 | $350.51 | $584.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.24 / $252.06 / $402.18
| Professional | | $32.24 | $252.06 | $402.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.72 / $405.57 / $669.19
| Professional | | $309.72 | $405.57 | $669.19 |