- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.73 / $316.20 / $497.53
| Professional | | $203.73 | $316.20 | $497.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.89 / $355.01 / $625.07
| Professional | | $229.89 | $355.01 | $625.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.00 / $355.36 / $595.69
| Professional | | $215.00 | $355.36 | $595.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,486.40 / $2,154.40 / $2,503.19
| Professional | | $1,486.40 | $2,154.40 | $2,503.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.63 / $471.66 / $807.46
| Professional | | $319.63 | $471.66 | $807.46 |