- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.49 / $394.01 / $1,502.22
| Professional | | $255.49 | $394.01 | $1,502.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.16 / $431.16 / $605.72
| Professional | | $431.16 | $431.16 | $605.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.10 / $431.16 / $663.48
| Professional | | $270.10 | $431.16 | $663.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.58 / $504.63 / $764.50
| Professional | | $324.58 | $504.63 | $764.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.14 / $628.65 / $711.68
| Professional | | $491.14 | $628.65 | $711.68 |