- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.35 / $225.40 / $1,134.05
| Professional | | $139.35 | $225.40 | $1,134.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.11 / $277.14 / $746.79
| Professional | | $235.11 | $277.14 | $746.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.96 / $283.77 / $746.79
| Professional | | $155.96 | $283.77 | $746.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.83 / $311.77 / $746.79
| Professional | | $184.83 | $311.77 | $746.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.92 / $300.45 / $916.61
| Professional | | $223.92 | $300.45 | $916.61 |