- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.74 / $379.29 / $716.23
| Professional | | $273.74 | $379.29 | $716.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.76 / $550.25 / $721.17
| Professional | | $394.76 | $550.25 | $721.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.37 / $275.13 / $456.24
| Professional | | $29.37 | $275.13 | $456.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.41 / $533.77 / $748.76
| Professional | | $397.41 | $533.77 | $748.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.75 / $491.04 / $730.17
| Professional | | $397.75 | $491.04 | $730.17 |