- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.86 / $343.29 / $592.99
| Professional | | $203.86 | $343.29 | $592.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.34 / $407.28 / $664.42
| Professional | | $184.34 | $407.28 | $664.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.92 / $325.49 / $615.77
| Professional | | $227.92 | $325.49 | $615.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.35 / $376.49 / $376.49
| Professional | | $341.35 | $376.49 | $376.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.58 / $493.50 / $1,183.07
| Professional | | $267.58 | $493.50 | $1,183.07 |