- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.81 / $324.33 / $614.82
| Professional | | $205.81 | $324.33 | $614.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.88 / $469.54 / $714.24
| Professional | | $224.88 | $469.54 | $714.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.83 / $369.32 / $752.95
| Professional | | $244.83 | $369.32 | $752.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.39 / $486.22 / $846.68
| Professional | | $361.39 | $486.22 | $846.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.94 / $480.54 / $1,173.15
| Professional | | $281.94 | $480.54 | $1,173.15 |