- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.66 / $284.20 / $516.35
| Professional | | $195.66 | $284.20 | $516.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.38 / $347.93 / $1,032.27
| Professional | | $284.38 | $347.93 | $1,032.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.25 / $302.14 / $807.08
| Professional | | $208.25 | $302.14 | $807.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.27 / $408.91 / $807.08
| Professional | | $269.27 | $408.91 | $807.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.55 / $398.20 / $1,161.09
| Professional | | $299.55 | $398.20 | $1,161.09 |