- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.55 / $252.49 / $517.61
| Professional | | $151.55 | $252.49 | $517.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.52 / $318.10 / $439.52
| Professional | | $172.52 | $318.10 | $439.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.04 / $357.11 / $618.01
| Professional | | $223.04 | $357.11 | $618.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.78 / $327.12 / $466.93
| Professional | | $221.78 | $327.12 | $466.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.79 / $493.70 / $770.94
| Professional | | $232.79 | $493.70 | $770.94 |