- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.40 / $236.30 / $396.57
| Professional | | $151.40 | $236.30 | $396.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.72 / $288.13 / $862.69
| Professional | | $234.72 | $288.13 | $862.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.60 / $248.53 / $666.86
| Professional | | $161.60 | $248.53 | $666.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.80 / $335.99 / $666.86
| Professional | | $206.80 | $335.99 | $666.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.36 / $295.86 / $951.05
| Professional | | $245.36 | $295.86 | $951.05 |