- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.78 / $246.80 / $286.33
| Professional | | $177.78 | $246.80 | $286.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.84 / $407.68 / $889.05
| Professional | | $345.84 | $407.68 | $889.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.10 / $368.92 / $542.02
| Professional | | $231.10 | $368.92 | $542.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.69 / $356.51 / $542.02
| Professional | | $281.69 | $356.51 | $542.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.23 / $340.44 / $989.68
| Professional | | $280.23 | $340.44 | $989.68 |