- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.55 / $276.33 / $393.69
| Professional | | $174.55 | $276.33 | $393.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.10 / $365.29 / $587.94
| Professional | | $219.10 | $365.29 | $587.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.21 / $353.35 / $668.48
| Professional | | $212.21 | $353.35 | $668.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,539.60 / $2,400.96 / $2,812.13
| Professional | | $1,539.60 | $2,400.96 | $2,812.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.15 / $464.05 / $782.74
| Professional | | $346.15 | $464.05 | $782.74 |