- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.04 / $483.55 / $850.56
| Professional | | $340.04 | $483.55 | $850.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.07 / $447.58 / $691.59
| Professional | | $252.07 | $447.58 | $691.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.10 / $580.00 / $906.37
| Professional | | $395.10 | $580.00 | $906.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $90.60 / $755.02
| Professional | | $32.34 | $90.60 | $755.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.80 / $623.57 / $1,025.25
| Professional | | $401.80 | $623.57 | $1,025.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.88 / $741.50 / $1,143.01
| Professional | | $517.88 | $741.50 | $1,143.01 |