- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.84 / $315.81 / $533.70
| Professional | | $218.84 | $315.81 | $533.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.20 / $325.70 / $436.28
| Professional | | $277.20 | $325.70 | $436.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.95 / $353.11 / $643.12
| Professional | | $233.95 | $353.11 | $643.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.95 / $430.38 / $2,529.28
| Professional | | $308.95 | $430.38 | $2,529.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.60 / $367.40 / $653.52
| Professional | | $300.60 | $367.40 | $653.52 |