- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.61 / $393.35 / $533.42
| Professional | | $324.61 | $393.35 | $533.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.00 / $160.00 / $468.71
| Facility | | $150.00 | $160.00 | $468.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.80 / $479.29 / $826.44
| Professional | | $355.80 | $479.29 | $826.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.33 / $491.31 / $701.86
| Professional | | $374.33 | $491.31 | $701.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.19 / $407.82 / $711.96
| Professional | | $306.19 | $407.82 | $711.96 |