- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.79 / $341.83 / $488.04
| Professional | | $246.79 | $341.83 | $488.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.20 / $336.35 / $529.44
| Professional | | $273.20 | $336.35 | $529.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.58 / $433.51 / $762.65
| Professional | | $299.58 | $433.51 | $762.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.34 / $573.03 / $2,857.44
| Professional | | $371.34 | $573.03 | $2,857.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.19 / $476.36 / $820.57
| Professional | | $361.19 | $476.36 | $820.57 |