- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.97 / $221.22 / $268.04
| Professional | | $156.97 | $221.22 | $268.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.81 / $420.37 / $648.22
| Professional | | $324.81 | $420.37 | $648.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.36 / $429.10 / $686.55
| Professional | | $245.36 | $429.10 | $686.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.42 / $481.57 / $1,217.44
| Professional | | $267.42 | $481.57 | $1,217.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.42 / $462.28 / $588.32
| Professional | | $267.42 | $462.28 | $588.32 |