- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.27 / $345.22 / $602.26
| Professional | | $245.27 | $345.22 | $602.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.23 / $449.63 / $690.28
| Professional | | $307.23 | $449.63 | $690.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.85 / $456.34 / $747.39
| Professional | | $322.85 | $456.34 | $747.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,001.28 / $2,767.12 / $3,206.93
| Professional | | $2,001.28 | $2,767.12 | $3,206.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.12 / $421.76 / $791.31
| Professional | | $341.12 | $421.76 | $791.31 |