- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.94 / $208.51 / $866.17
| Professional | | $146.94 | $208.51 | $866.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.15 / $286.57 / $425.98
| Professional | | $156.15 | $286.57 | $425.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.32 / $451.88 / $637.17
| Professional | | $260.32 | $451.88 | $637.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.70 / $440.87 / $1,192.96
| Professional | | $272.70 | $440.87 | $1,192.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.94 / $426.33 / $598.19
| Professional | | $322.94 | $426.33 | $598.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.70 / $440.87 / $574.45
| Professional | | $272.70 | $440.87 | $574.45 |