- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.59 / $328.82 / $328.83
| Professional | | $220.59 | $328.82 | $328.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.06 / $407.16 / $476.66
| Professional | | $270.06 | $407.16 | $476.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.89 / $311.66 / $453.33
| Professional | | $227.89 | $311.66 | $453.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.16 / $504.89 / $2,192.56
| Professional | | $304.16 | $504.89 | $2,192.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.91 / $376.52 / $588.92
| Professional | | $293.91 | $376.52 | $588.92 |