- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.49 / $347.59 / $610.04
| Professional | | $255.49 | $347.59 | $610.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.83 / $382.17 / $506.02
| Professional | | $324.83 | $382.17 | $506.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.83 / $444.59 / $751.57
| Professional | | $310.83 | $444.59 | $751.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.28 / $510.50 / $2,857.44
| Professional | | $389.28 | $510.50 | $2,857.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.96 / $448.49 / $622.04
| Professional | | $380.96 | $448.49 | $622.04 |