- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.24 / $355.11 / $575.90
| Professional | | $241.24 | $355.11 | $575.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.86 / $324.86 / $449.94
| Professional | | $324.86 | $324.86 | $449.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.63 / $389.44 / $669.78
| Professional | | $267.63 | $389.44 | $669.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.04 / $544.61 / $2,529.28
| Professional | | $354.04 | $544.61 | $2,529.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.70 / $406.75 / $659.60
| Professional | | $344.70 | $406.75 | $659.60 |