- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.81 / $214.46 / $318.66
| Professional | | $205.81 | $214.46 | $318.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.72 / $353.30 / $995.59
| Professional | | $299.72 | $353.30 | $995.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.20 / $357.11 / $605.15
| Professional | | $232.20 | $357.11 | $605.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.45 / $363.85 / $605.15
| Professional | | $244.45 | $363.85 | $605.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.33 / $380.09 / $1,104.94
| Professional | | $305.33 | $380.09 | $1,104.94 |