- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.28 / $244.57 / $284.27
| Professional | | $186.28 | $244.57 | $284.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.10 / $419.76 / $849.12
| Professional | | $356.10 | $419.76 | $849.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.63 / $365.71 / $531.30
| Professional | | $242.63 | $365.71 | $531.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.97 / $365.71 / $531.30
| Professional | | $275.97 | $365.71 | $531.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.25 / $333.70 / $970.10
| Professional | | $276.25 | $333.70 | $970.10 |