- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.98 / $248.97 / $470.02
| Professional | | $171.98 | $248.97 | $470.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.48 / $327.19 / $1,002.63
| Professional | | $269.48 | $327.19 | $1,002.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.32 / $272.41 / $701.89
| Professional | | $184.32 | $272.41 | $701.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.93 / $357.50 / $701.89
| Professional | | $246.93 | $357.50 | $701.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.92 / $331.09 / $1,007.46
| Professional | | $259.92 | $331.09 | $1,007.46 |