- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.65 / $250.66 / $1,002.97
| Professional | | $150.65 | $250.66 | $1,002.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.09 / $284.13 / $477.58
| Professional | | $192.09 | $284.13 | $477.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.98 / $169.75 / $229.06
| Professional | | $25.98 | $169.75 | $229.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.05 / $377.39 / $580.54
| Professional | | $216.05 | $377.39 | $580.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.26 / $266.76 / $435.01
| Professional | | $221.26 | $266.76 | $435.01 |