- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.12 / $184.84 / $354.11
| Professional | | $105.12 | $184.84 | $354.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.21 / $221.73 / $358.58
| Professional | | $158.21 | $221.73 | $358.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.86 / $185.41 / $231.76
| Professional | | $151.86 | $185.41 | $231.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.08 / $244.39 / $368.73
| Professional | | $149.08 | $244.39 | $368.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.23 / $243.61 / $375.06
| Professional | | $195.23 | $243.61 | $375.06 |