- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.76 / $268.16 / $532.37
| Professional | | $160.76 | $268.16 | $532.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.04 / $338.58 / $465.17
| Professional | | $185.04 | $338.58 | $465.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.27 / $373.60 / $645.41
| Professional | | $245.27 | $373.60 | $645.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.69 / $360.64 / $492.64
| Professional | | $234.69 | $360.64 | $492.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.34 / $510.39 / $799.67
| Professional | | $248.34 | $510.39 | $799.67 |