- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.12 / $229.75 / $298.64
| Professional | | $186.12 | $229.75 | $298.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.13 / $482.58 / $671.45
| Professional | | $374.13 | $482.58 | $671.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.41 / $540.97 / $767.01
| Professional | | $347.41 | $540.97 | $767.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.60 / $524.44 / $2,148.96
| Professional | | $304.60 | $524.44 | $2,148.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.29 / $452.58 / $780.47
| Professional | | $279.29 | $452.58 | $780.47 |