- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.59 / $241.38 / $1,070.09
| Professional | | $180.59 | $241.38 | $1,070.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.80 / $311.80 / $437.47
| Professional | | $311.80 | $311.80 | $437.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.02 / $349.78 / $458.62
| Professional | | $265.02 | $349.78 | $458.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.07 / $365.59 / $520.65
| Professional | | $262.07 | $365.59 | $520.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.80 / $466.10 / $505.60
| Professional | | $410.80 | $466.10 | $505.60 |