- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.57 / $231.67 / $387.05
| Professional | | $150.57 | $231.67 | $387.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.25 / $500.10 / $867.31
| Professional | | $424.25 | $500.10 | $867.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.92 / $261.18 / $412.00
| Professional | | $204.92 | $261.18 | $412.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.00 / $261.18 / $407.69
| Professional | | $145.00 | $261.18 | $407.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.13 / $320.18 / $971.32
| Professional | | $268.13 | $320.18 | $971.32 |