- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.40 / $246.21 / $427.77
| Professional | | $155.40 | $246.21 | $427.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.24 / $299.70 / $479.63
| Professional | | $186.24 | $299.70 | $479.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.50 / $300.02 / $486.41
| Professional | | $195.50 | $300.02 | $486.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,282.64 / $1,965.04 / $2,302.88
| Professional | | $1,282.64 | $1,965.04 | $2,302.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.03 / $299.51 / $558.63
| Professional | | $237.03 | $299.51 | $558.63 |