- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.58 / $267.11 / $1,127.22
| Professional | | $202.58 | $267.11 | $1,127.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.66 / $756.84 / $756.84
| Professional | | $524.66 | $756.84 | $756.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.68 / $355.79 / $756.84
| Professional | | $219.68 | $355.79 | $756.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.69 / $356.47 / $756.84
| Professional | | $225.69 | $356.47 | $756.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.95 / $303.23 / $928.94
| Professional | | $276.95 | $303.23 | $928.94 |