- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.88 / $305.07 / $543.45
| Professional | | $219.88 | $305.07 | $543.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.30 / $416.01 / $530.49
| Professional | | $314.30 | $416.01 | $530.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.65 / $257.37 / $349.34
| Professional | | $25.65 | $257.37 | $349.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.05 / $419.64 / $555.99
| Professional | | $297.05 | $419.64 | $555.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.22 / $366.48 / $554.01
| Professional | | $295.22 | $366.48 | $554.01 |