- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.72 / $253.42 / $393.33
| Professional | | $150.72 | $253.42 | $393.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.67 / $274.54 / $485.16
| Professional | | $169.67 | $274.54 | $485.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.81 / $264.25 / $461.29
| Professional | | $155.81 | $264.25 | $461.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,074.72 / $1,625.84 / $1,892.55
| Professional | | $1,074.72 | $1,625.84 | $1,892.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.56 / $374.54 / $686.84
| Professional | | $250.56 | $374.54 | $686.84 |