- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.80 / $216.30 / $451.79
| Professional | | $153.80 | $216.30 | $451.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.52 / $255.46 / $398.47
| Professional | | $184.52 | $255.46 | $398.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.32 / $157.59 / $202.48
| Professional | | $126.32 | $157.59 | $202.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.07 / $292.79 / $398.65
| Professional | | $222.07 | $292.79 | $398.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.10 / $275.19 / $452.60
| Professional | | $189.10 | $275.19 | $452.60 |