- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.87 / $309.75 / $347.45
| Professional | | $197.87 | $309.75 | $347.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.57 / $505.10 / $710.90
| Professional | | $390.57 | $505.10 | $710.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.39 / $467.07 / $781.45
| Professional | | $240.39 | $467.07 | $781.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.61 / $527.90 / $1,491.84
| Professional | | $322.61 | $527.90 | $1,491.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.54 / $494.91 / $724.59
| Professional | | $312.54 | $494.91 | $724.59 |