- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.74 / $253.90 / $453.43
| Professional | | $184.74 | $253.90 | $453.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.54 / $489.83 / $983.75
| Professional | | $415.54 | $489.83 | $983.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.23 / $361.57 / $493.32
| Professional | | $248.23 | $361.57 | $493.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.23 / $361.57 / $493.32
| Professional | | $248.23 | $361.57 | $493.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.71 / $398.19 / $1,157.56
| Professional | | $337.71 | $398.19 | $1,157.56 |