- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.59 / $299.37 / $449.06
| Professional | | $183.59 | $299.37 | $449.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.26 / $335.29 / $678.55
| Professional | | $187.26 | $335.29 | $678.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.93 / $330.29 / $617.58
| Professional | | $196.93 | $330.29 | $617.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,440.08 / $2,568.83 / $3,368.74
| Professional | | $1,440.08 | $2,568.83 | $3,368.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.79 / $356.20 / $601.70
| Professional | | $285.79 | $356.20 | $601.70 |