- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.15 / $408.43 / $736.37
| Professional | | $251.15 | $408.43 | $736.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.06 / $610.65 / $901.78
| Professional | | $268.06 | $610.65 | $901.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.00 / $475.50 / $841.05
| Professional | | $290.00 | $475.50 | $841.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.87 / $545.94 / $691.56
| Professional | | $411.87 | $545.94 | $691.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.98 / $537.22 / $1,441.20
| Professional | | $306.98 | $537.22 | $1,441.20 |