- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.65 / $326.58 / $592.26
| Professional | | $184.65 | $326.58 | $592.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.61 / $387.28 / $635.07
| Professional | | $239.61 | $387.28 | $635.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.98 / $229.59 / $339.80
| Professional | | $28.98 | $229.59 | $339.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.33 / $427.04 / $689.76
| Professional | | $241.33 | $427.04 | $689.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.48 / $429.10 / $654.19
| Professional | | $371.48 | $429.10 | $654.19 |