- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.63 / $240.45 / $360.08
| Professional | | $159.63 | $240.45 | $360.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.30 / $205.97 / $326.57
| Professional | | $168.30 | $205.97 | $326.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.64 / $304.97 / $533.61
| Professional | | $192.64 | $304.97 | $533.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.63 / $407.88 / $2,040.64
| Professional | | $262.63 | $407.88 | $2,040.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.92 / $336.65 / $574.40
| Professional | | $256.92 | $336.65 | $574.40 |