- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.61 / $243.61 / $387.54
| Professional | | $172.61 | $243.61 | $387.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.87 / $303.38 / $403.75
| Professional | | $257.87 | $303.38 | $403.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.35 / $322.25 / $449.89
| Professional | | $219.35 | $322.25 | $449.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.24 / $338.11 / $2,126.08
| Professional | | $276.24 | $338.11 | $2,126.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.41 / $311.63 / $480.57
| Professional | | $271.41 | $311.63 | $480.57 |