- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.53 / $315.91 / $539.02
| Professional | | $200.53 | $315.91 | $539.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.79 / $269.16 / $450.61
| Professional | | $228.79 | $269.16 | $450.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.67 / $364.18 / $637.71
| Professional | | $213.67 | $364.18 | $637.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.56 / $454.20 / $2,511.52
| Professional | | $354.56 | $454.20 | $2,511.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.22 / $399.03 / $562.11
| Professional | | $346.22 | $399.03 | $562.11 |