- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.47 / $247.16 / $396.08
| Professional | | $148.47 | $247.16 | $396.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.91 / $298.39 / $435.44
| Professional | | $191.91 | $298.39 | $435.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.87 / $147.62 / $183.67
| Professional | | $118.87 | $147.62 | $183.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.08 / $382.82 / $478.75
| Professional | | $286.08 | $382.82 | $478.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.28 / $232.43 / $334.28
| Professional | | $157.28 | $232.43 | $334.28 |