- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.94 / $248.28 / $801.36
| Professional | | $220.94 | $248.28 | $801.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.66 / $398.39 / $711.59
| Professional | | $315.66 | $398.39 | $711.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.05 / $313.80 / $532.82
| Professional | | $234.05 | $313.80 | $532.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.05 / $313.80 / $532.82
| Professional | | $234.05 | $313.80 | $532.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.99 / $335.85 / $553.24
| Professional | | $250.99 | $335.85 | $553.24 |