- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $245.47 / $512.86
| Professional | | $138.04 | $245.47 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $478.63 / $912.01
| Professional | | $257.04 | $478.63 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $512.86 / $1,023.29
| Professional | | $251.19 | $512.86 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $524.81 / $977.24
| Professional | | $316.23 | $524.81 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $501.19 / $1,995.26
| Professional | | $239.88 | $501.19 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $331.13 / $758.58
| Professional | | $162.18 | $331.13 | $758.58 |