- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.28 / $235.78 / $903.87
| Professional | | $152.28 | $235.78 | $903.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.83 / $602.83 / $722.26
| Professional | | $602.83 | $602.83 | $722.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.61 / $115.80 / $144.86
| Professional | | $94.61 | $115.80 | $144.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.35 / $315.14 / $394.11
| Professional | | $235.35 | $315.14 | $394.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.77 / $200.79 / $271.86
| Professional | | $144.77 | $200.79 | $271.86 |