- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.15 / $274.52 / $315.14
| Professional | | $198.15 | $274.52 | $315.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.14 / $363.22 / $987.34
| Professional | | $308.14 | $363.22 | $987.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.52 / $413.73 / $593.60
| Professional | | $265.52 | $413.73 | $593.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.13 / $391.52 / $593.60
| Professional | | $316.13 | $391.52 | $593.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.42 / $372.83 / $1,083.85
| Professional | | $301.42 | $372.83 | $1,083.85 |