- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.86 / $242.85 / $391.58
| Professional | | $159.86 | $242.85 | $391.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.13 / $308.58 / $366.11
| Professional | | $153.13 | $308.58 | $366.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.03 / $323.56 / $588.66
| Professional | | $208.03 | $323.56 | $588.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.00 / $354.91 / $383.55
| Professional | | $148.00 | $354.91 | $383.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.22 / $356.88 / $667.88
| Professional | | $222.22 | $356.88 | $667.88 |