- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.40 / $150.97 / $206.19
| Professional | | $150.40 | $150.97 | $206.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.84 / $643.84 / $643.84
| Professional | | $643.84 | $643.84 | $643.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.53 / $225.05 / $392.19
| Professional | | $154.53 | $225.05 | $392.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.66 / $234.42 / $350.90
| Professional | | $167.66 | $234.42 | $350.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.31 / $247.18 / $716.10
| Professional | | $233.31 | $247.18 | $716.10 |