- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.78 / $334.58 / $699.14
| Professional | | $140.78 | $334.58 | $699.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.82 / $374.82 / $441.83
| Professional | | $374.82 | $374.82 | $441.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.97 / $300.52 / $1,001.82
| Professional | | $172.97 | $300.52 | $1,001.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.70 / $414.67 / $1,001.82
| Professional | | $194.70 | $414.67 | $1,001.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.01 / $466.16 / $1,229.63
| Professional | | $364.01 | $466.16 | $1,229.63 |