- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.15 / $270.60 / $295.67
| Professional | | $195.15 | $270.60 | $295.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.77 / $460.63 / $915.77
| Professional | | $390.77 | $460.63 | $915.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.34 / $397.82 / $560.74
| Professional | | $247.34 | $397.82 | $560.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.06 / $368.93 / $560.74
| Professional | | $306.06 | $368.93 | $560.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.22 / $352.20 / $1,023.86
| Professional | | $299.22 | $352.20 | $1,023.86 |