- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $380.19 / $645.65
| Professional | | $281.84 | $380.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $478.63 / $676.08
| Professional | | $251.19 | $478.63 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $575.44 / $1,122.02
| Professional | | $354.81 | $575.44 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $524.81 / $912.01
| Professional | | $309.03 | $524.81 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $512.86 / $954.99
| Professional | | $323.59 | $512.86 | $954.99 |