- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.05 / $341.83 / $760.92
| Professional | | $249.05 | $341.83 | $760.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.20 / $407.75 / $509.80
| Professional | | $326.20 | $407.75 | $509.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.88 / $398.58 / $675.39
| Professional | | $270.88 | $398.58 | $675.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.93 / $440.01 / $2,857.44
| Professional | | $328.93 | $440.01 | $2,857.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.79 / $391.16 / $778.41
| Professional | | $317.79 | $391.16 | $778.41 |