- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.38 / $259.70 / $452.40
| Professional | | $171.38 | $259.70 | $452.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.64 / $320.08 / $977.62
| Professional | | $263.64 | $320.08 | $977.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.78 / $274.12 / $732.48
| Professional | | $182.78 | $274.12 | $732.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.48 / $372.27 / $732.48
| Professional | | $236.48 | $372.27 | $732.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.85 / $334.89 / $1,053.70
| Professional | | $271.85 | $334.89 | $1,053.70 |