- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.43 / $277.77 / $315.19
| Professional | | $200.43 | $277.77 | $315.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.47 / $383.65 / $985.58
| Professional | | $325.47 | $383.65 | $985.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.85 / $418.00 / $592.40
| Professional | | $268.85 | $418.00 | $592.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.89 / $390.79 / $592.40
| Professional | | $319.89 | $390.79 | $592.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.39 / $372.08 / $1,081.66
| Professional | | $305.39 | $372.08 | $1,081.66 |