- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.38 / $242.33 / $413.07
| Professional | | $157.38 | $242.33 | $413.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.97 / $327.78 / $1,004.42
| Professional | | $269.97 | $327.78 | $1,004.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.05 / $256.45 / $688.00
| Professional | | $168.05 | $256.45 | $688.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.49 / $348.37 / $688.00
| Professional | | $215.49 | $348.37 | $688.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.96 / $338.62 / $984.39
| Professional | | $253.96 | $338.62 | $984.39 |