- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.43 / $228.47 / $497.89
| Professional | | $183.43 | $228.47 | $497.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.52 / $366.87 / $366.87
| Professional | | $333.52 | $366.87 | $366.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.23 / $213.23 / $213.23
| Professional | | $213.23 | $213.23 | $213.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.65 / $488.65 / $488.65
| Professional | | $488.65 | $488.65 | $488.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.69 / $221.62 / $362.25
| Professional | | $184.69 | $221.62 | $362.25 |