- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.65 / $272.58 / $714.63
| Professional | | $134.65 | $272.58 | $714.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.38 / $321.38 / $1,156.47
| Professional | | $321.38 | $321.38 | $1,156.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.85 / $351.55 / $1,156.47
| Professional | | $185.85 | $351.55 | $1,156.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.98 / $373.42 / $1,156.47
| Professional | | $192.98 | $373.42 | $1,156.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.64 / $412.17 / $1,419.44
| Professional | | $287.64 | $412.17 | $1,419.44 |