- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.67 / $312.43 / $1,057.25
| Professional | | $229.67 | $312.43 | $1,057.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.80 / $349.80 / $349.80
| Professional | | $349.80 | $349.80 | $349.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.13 / $402.37 / $698.51
| Professional | | $278.13 | $402.37 | $698.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.13 / $402.37 / $535.54
| Professional | | $278.13 | $402.37 | $535.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.57 / $420.78 / $819.56
| Professional | | $207.57 | $420.78 | $819.56 |