- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.41 / $225.23 / $343.21
| Professional | | $174.41 | $225.23 | $343.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.66 / $147.66 / $147.66
| Professional | | $147.66 | $147.66 | $147.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.93 / $264.38 / $407.93
| Professional | | $184.93 | $264.38 | $407.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.93 / $277.83 / $476.68
| Professional | | $184.93 | $277.83 | $476.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,722.48 / $1,774.15 / $1,774.15
| Professional | | $1,722.48 | $1,774.15 | $1,774.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.77 / $240.97 / $414.66
| Professional | | $182.77 | $240.97 | $414.66 |