- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.24 / $314.45 / $401.78
| Professional | | $241.24 | $314.45 | $401.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.75 / $300.38 / $440.71
| Professional | | $218.75 | $300.38 | $440.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.37 / $363.38 / $530.48
| Professional | | $250.37 | $363.38 | $530.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.01 / $442.55 / $2,529.28
| Professional | | $308.01 | $442.55 | $2,529.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.93 / $385.98 / $563.35
| Professional | | $300.93 | $385.98 | $563.35 |