- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.50 / $204.24 / $270.01
| Professional | | $189.50 | $204.24 | $270.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.35 / $344.61 / $819.02
| Professional | | $292.35 | $344.61 | $819.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.65 / $300.19 / $505.23
| Professional | | $209.65 | $300.19 | $505.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.06 / $300.57 / $505.23
| Professional | | $231.06 | $300.57 | $505.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.94 / $317.32 / $922.48
| Professional | | $247.94 | $317.32 | $922.48 |