- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.83 / $203.72 / $331.33
| Professional | | $144.83 | $203.72 | $331.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.52 / $484.65 / $737.63
| Professional | | $467.52 | $484.65 | $737.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.45 / $281.27 / $358.56
| Professional | | $182.45 | $281.27 | $358.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.45 / $277.58 / $358.56
| Professional | | $182.45 | $277.58 | $358.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.06 / $253.79 / $834.21
| Professional | | $235.06 | $253.79 | $834.21 |