- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.96 / $228.88 / $271.24
| Professional | | $115.96 | $228.88 | $271.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.79 / $289.70 / $489.01
| Professional | | $182.79 | $289.70 | $489.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.33 / $308.68 / $604.44
| Professional | | $182.33 | $308.68 | $604.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.66 / $448.82 / $1,494.45
| Professional | | $248.66 | $448.82 | $1,494.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.02 / $364.26 / $533.05
| Professional | | $239.02 | $364.26 | $533.05 |