- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.87 / $223.37 / $408.85
| Professional | | $176.87 | $223.37 | $408.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.50 / $184.50 / $185.36
| Professional | | $184.50 | $184.50 | $185.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.38 / $601.65 / $670.68
| Professional | | $501.38 | $601.65 | $670.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.25 / $473.25 / $946.50
| Professional | | $284.25 | $473.25 | $946.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.92 / $476.78 / $1,021.35
| Professional | | $237.92 | $476.78 | $1,021.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.17 / $609.50 / $767.08
| Professional | | $607.17 | $609.50 | $767.08 |