- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.62 / $314.41 / $415.93
| Professional | | $222.62 | $314.41 | $415.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.85 / $344.36 / $566.59
| Professional | | $255.85 | $344.36 | $566.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.38 / $387.40 / $689.25
| Professional | | $252.38 | $387.40 | $689.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.42 / $675.87 / $2,529.28
| Professional | | $344.42 | $675.87 | $2,529.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.64 / $490.77 / $951.53
| Professional | | $318.64 | $490.77 | $951.53 |