- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.32 / $205.08 / $312.29
| Professional | | $193.32 | $205.08 | $312.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.91 / $436.05 / $947.56
| Professional | | $369.91 | $436.05 | $947.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.89 / $345.05 / $589.89
| Professional | | $212.89 | $345.05 | $589.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.59 / $354.22 / $589.89
| Professional | | $231.59 | $354.22 | $589.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.39 / $370.50 / $1,077.06
| Professional | | $281.39 | $370.50 | $1,077.06 |