- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.40 / $292.10 / $409.21
| Professional | | $204.40 | $292.10 | $409.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.35 / $413.37 / $863.30
| Professional | | $210.35 | $413.37 | $863.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.85 / $450.58 / $554.28
| Professional | | $342.85 | $450.58 | $554.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.06 / $357.01 / $579.74
| Professional | | $189.06 | $357.01 | $579.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.71 / $399.21 / $870.66
| Professional | | $202.71 | $399.21 | $870.66 |