- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.60 / $211.64 / $470.20
| Professional | | $146.60 | $211.64 | $470.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.68 / $294.10 / $347.62
| Professional | | $198.68 | $294.10 | $347.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.30 / $358.53 / $488.64
| Professional | | $245.30 | $358.53 | $488.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.62 / $281.64 / $345.49
| Professional | | $189.62 | $281.64 | $345.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.13 / $299.74 / $601.33
| Professional | | $199.13 | $299.74 | $601.33 |