- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.54 / $245.17 / $459.43
| Professional | | $146.54 | $245.17 | $459.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.29 / $311.69 / $430.67
| Professional | | $167.29 | $311.69 | $430.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.92 / $346.50 / $611.09
| Professional | | $226.92 | $346.50 | $611.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.75 / $322.19 / $465.69
| Professional | | $218.75 | $322.19 | $465.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.74 / $451.89 / $762.30
| Professional | | $231.74 | $451.89 | $762.30 |