- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.64 / $266.52 / $301.19
| Professional | | $260.64 | $266.52 | $301.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.99 / $361.10 / $595.82
| Professional | | $324.99 | $361.10 | $595.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.20 / $703.51 / $1,224.36
| Professional | | $315.20 | $703.51 | $1,224.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.77 / $655.71 / $655.71
| Professional | | $297.77 | $655.71 | $655.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.97 / $394.88 / $830.36
| Professional | | $244.97 | $394.88 | $830.36 |