- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.34 / $239.92 / $367.68
| Professional | | $173.34 | $239.92 | $367.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.77 / $190.96 / $265.08
| Professional | | $156.77 | $190.96 | $265.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.99 / $262.05 / $437.47
| Professional | | $182.99 | $262.05 | $437.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.12 / $279.82 / $2,069.67
| Professional | | $231.12 | $279.82 | $2,069.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.24 / $268.60 / $355.50
| Professional | | $226.24 | $268.60 | $355.50 |