- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.58 / $285.82 / $348.43
| Professional | | $263.58 | $285.82 | $348.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $369.66 / $587.11
| Professional | | $316.23 | $369.66 | $587.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.55 / $404.86 / $477.73
| Professional | | $295.55 | $404.86 | $477.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.44 / $385.39 / $760.68
| Professional | | $278.44 | $385.39 | $760.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.02 / $335.73 / $449.44
| Professional | | $260.02 | $335.73 | $449.44 |