- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.27 / $243.56 / $848.64
| Professional | | $142.27 | $243.56 | $848.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.33 / $276.47 / $406.44
| Professional | | $251.33 | $276.47 | $406.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.94 / $251.33 / $421.37
| Professional | | $148.94 | $251.33 | $421.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.34 / $308.51 / $506.69
| Professional | | $189.34 | $308.51 | $506.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.39 / $412.72 / $471.68
| Professional | | $346.39 | $412.72 | $471.68 |