- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.53 / $230.27 / $473.68
| Professional | | $180.53 | $230.27 | $473.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.89 / $334.97 / $1,024.09
| Professional | | $275.89 | $334.97 | $1,024.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.64 / $271.38 / $680.15
| Professional | | $196.64 | $271.38 | $680.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.51 / $348.09 / $680.15
| Professional | | $246.51 | $348.09 | $680.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.58 / $332.77 / $1,051.79
| Professional | | $269.58 | $332.77 | $1,051.79 |