- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.56 / $271.31 / $289.33
| Professional | | $195.56 | $271.31 | $289.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.72 / $310.86 / $871.63
| Professional | | $263.72 | $310.86 | $871.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.01 / $382.35 / $541.41
| Professional | | $257.01 | $382.35 | $541.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.39 / $361.97 / $541.41
| Professional | | $294.39 | $361.97 | $541.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.75 / $329.87 / $958.95
| Professional | | $270.75 | $329.87 | $958.95 |