- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $208.93 / $467.74
| Professional | | $154.88 | $208.93 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $1,698.24 / $4,073.80
| Professional | | $158.49 | $1,698.24 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $281.84 / $549.54
| Professional | | $162.18 | $281.84 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $371.54 / $524.81
| Professional | | $251.19 | $371.54 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $275.42 / $478.63
| Professional | | $151.36 | $275.42 | $478.63 |