- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.70 / $424.51 / $507.89
| Professional | | $339.70 | $424.51 | $507.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.39 / $433.09 / $541.36
| Professional | | $237.39 | $433.09 | $541.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.51 / $453.02 / $653.40
| Professional | | $340.51 | $453.02 | $653.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.24 / $303.76 / $508.16
| Professional | | $32.24 | $303.76 | $508.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.58 / $453.64 / $793.87
| Professional | | $344.58 | $453.64 | $793.87 |