- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.86 / $346.20 / $468.17
| Professional | | $127.86 | $346.20 | $468.17 |
- 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
- $466.44 / $488.65 / $599.71
| Professional | | $466.44 | $488.65 | $599.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.11 / $288.11 / $288.11
| Professional | | $288.11 | $288.11 | $288.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.91 / $231.88 / $266.75
| Professional | | $204.91 | $231.88 | $266.75 |