- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.62 / $266.69 / $282.06
| Professional | | $200.62 | $266.69 | $282.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.68 / $400.40 / $798.75
| Professional | | $339.68 | $400.40 | $798.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.61 / $390.98 / $507.56
| Professional | | $248.61 | $390.98 | $507.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.65 / $344.37 / $507.56
| Professional | | $237.65 | $344.37 | $507.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.11 / $318.79 / $926.76
| Professional | | $303.11 | $318.79 | $926.76 |