- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.88 / $228.57 / $466.24
| Professional | | $149.88 | $228.57 | $466.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.33 / $263.75 / $388.90
| Professional | | $185.33 | $263.75 | $388.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.06 / $355.75 / $721.44
| Professional | | $238.06 | $355.75 | $721.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.37 / $331.02 / $345.80
| Professional | | $281.37 | $331.02 | $345.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.42 / $345.83 / $576.65
| Professional | | $242.42 | $345.83 | $576.65 |