- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.46 / $220.09 / $271.68
| Professional | | $155.46 | $220.09 | $271.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.95 / $407.61 / $640.77
| Professional | | $314.95 | $407.61 | $640.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.55 / $415.69 / $676.72
| Professional | | $234.55 | $415.69 | $676.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.98 / $477.10 / $1,181.11
| Professional | | $265.98 | $477.10 | $1,181.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.98 / $457.34 / $585.16
| Professional | | $265.98 | $457.34 | $585.16 |