- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.10 / $224.53 / $320.60
| Professional | | $161.10 | $224.53 | $320.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.49 / $278.64 / $441.63
| Professional | | $194.49 | $278.64 | $441.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.25 / $284.51 / $588.35
| Professional | | $190.25 | $284.51 | $588.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,457.68 / $2,011.20 / $2,315.48
| Professional | | $1,457.68 | $2,011.20 | $2,315.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.93 / $315.95 / $574.64
| Professional | | $247.93 | $315.95 | $574.64 |