- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.05 / $341.83 / $393.03
| Professional | | $249.05 | $341.83 | $393.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.59 / $332.64 / $471.32
| Professional | | $212.59 | $332.64 | $471.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.89 / $415.07 / $622.61
| Professional | | $345.89 | $415.07 | $622.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.00 / $383.92 / $625.24
| Professional | | $271.00 | $383.92 | $625.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.04 / $404.31 / $774.17
| Professional | | $315.04 | $404.31 | $774.17 |