- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.56 / $234.83 / $331.85
| Professional | | $181.56 | $234.83 | $331.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.52 / $333.32 / $1,013.79
| Professional | | $274.52 | $333.32 | $1,013.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.73 / $269.19 / $659.87
| Professional | | $194.73 | $269.19 | $659.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.49 / $334.35 / $659.87
| Professional | | $240.49 | $334.35 | $659.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.49 / $291.74 / $932.17
| Professional | | $240.49 | $291.74 | $932.17 |