- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $229.09 / $524.81
| Professional | | $147.91 | $229.09 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $302.00 / $467.74
| Professional | | $199.53 | $302.00 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $389.05 / $645.65
| Professional | | $251.19 | $389.05 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $363.08 / $562.34
| Professional | | $218.78 | $363.08 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $288.40 / $954.99
| Professional | | $173.78 | $288.40 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $338.84 / $562.34
| Professional | | $218.78 | $338.84 | $562.34 |