- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.51 / $283.64 / $546.67
| Professional | | $201.51 | $283.64 | $546.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.23 / $387.60 / $1,187.73
| Professional | | $319.23 | $387.60 | $1,187.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.95 / $318.04 / $797.06
| Professional | | $214.95 | $318.04 | $797.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.07 / $405.57 / $797.06
| Professional | | $287.07 | $405.57 | $797.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.79 / $362.96 / $1,146.49
| Professional | | $295.79 | $362.96 | $1,146.49 |