- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.33 / $239.12 / $1,081.31
| Professional | | $178.33 | $239.12 | $1,081.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.06 / $317.06 / $449.56
| Professional | | $317.06 | $317.06 | $449.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.50 / $350.95 / $464.44
| Professional | | $269.50 | $350.95 | $464.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.56 / $370.65 / $535.74
| Professional | | $268.56 | $370.65 | $535.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.64 / $476.12 / $511.47
| Professional | | $426.64 | $476.12 | $511.47 |