- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.24 / $260.48 / $285.58
| Professional | | $221.24 | $260.48 | $285.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.79 / $275.79 / $890.33
| Professional | | $275.79 | $275.79 | $890.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.93 / $372.29 / $523.57
| Professional | | $259.93 | $372.29 | $523.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.14 / $346.06 / $523.57
| Professional | | $284.14 | $346.06 | $523.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.64 / $328.85 / $955.98
| Professional | | $260.64 | $328.85 | $955.98 |