- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.68 / $291.17 / $345.92
| Professional | | $240.68 | $291.17 | $345.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.04 / $298.51 / $548.33
| Professional | | $267.04 | $298.51 | $548.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $178.10 / $235.83
| Professional | | $32.34 | $178.10 | $235.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.91 / $402.25 / $439.08
| Professional | | $341.91 | $402.25 | $439.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.08 / $281.60 / $415.36
| Professional | | $214.08 | $281.60 | $415.36 |