- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.13 / $230.05 / $329.74
| Professional | | $163.13 | $230.05 | $329.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.49 / $278.14 / $454.75
| Professional | | $193.49 | $278.14 | $454.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.29 / $290.99 / $598.12
| Professional | | $193.29 | $290.99 | $598.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,477.92 / $2,062.40 / $2,378.85
| Professional | | $1,477.92 | $2,062.40 | $2,378.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.06 / $307.75 / $590.09
| Professional | | $249.06 | $307.75 | $590.09 |