- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.19 / $319.93 / $1,239.77
| Professional | | $207.19 | $319.93 | $1,239.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.80 / $209.89 / $279.85
| Professional | | $180.80 | $209.89 | $279.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.71 / $304.73 / $541.85
| Professional | | $189.71 | $304.73 | $541.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.76 / $341.88 / $3,261.12
| Professional | | $276.76 | $341.88 | $3,261.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.26 / $311.76 / $588.07
| Professional | | $272.26 | $311.76 | $588.07 |