- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.79 / $228.38 / $579.49
| Professional | | $120.79 | $228.38 | $579.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.60 / $244.21 / $428.63
| Professional | | $157.60 | $244.21 | $428.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.65 / $165.45 / $229.06
| Professional | | $25.65 | $165.45 | $229.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.53 / $286.17 / $408.26
| Professional | | $189.53 | $286.17 | $408.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.48 / $271.02 / $443.52
| Professional | | $196.48 | $271.02 | $443.52 |