- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.78 / $193.94 / $195.93
| Professional | | $153.78 | $193.94 | $195.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.35 / $323.39 / $600.79
| Professional | | $274.35 | $323.39 | $600.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.41 / $235.65 / $387.70
| Professional | | $189.41 | $235.65 | $387.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.47 / $236.49 / $387.70
| Professional | | $181.47 | $236.49 | $387.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.58 / $243.50 / $707.88
| Professional | | $228.58 | $243.50 | $707.88 |