- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.13 / $258.80 / $351.86
| Professional | | $185.13 | $258.80 | $351.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.66 / $300.18 / $414.22
| Professional | | $197.66 | $300.18 | $414.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.94 / $346.18 / $498.50
| Professional | | $276.94 | $346.18 | $498.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.71 / $313.54 / $657.71
| Professional | | $197.71 | $313.54 | $657.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.62 / $335.71 / $599.57
| Professional | | $275.62 | $335.71 | $599.57 |