- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $245.47 / $524.81
| Professional | | $151.36 | $245.47 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $162.18 / $199.53
| Professional | | $141.25 | $162.18 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $251.19 / $489.78
| Professional | | $154.88 | $251.19 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $281.84 / $524.81
| Professional | | $213.80 | $281.84 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $257.04 / $457.09
| Professional | | $151.36 | $257.04 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $316.23 / $371.54
| Professional | | $218.78 | $316.23 | $371.54 |