- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.08 / $179.29 / $500.67
| Professional | | $152.08 | $179.29 | $500.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.30 / $196.48 / $363.08
| Professional | | $130.30 | $196.48 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.20 / $570.36 / $722.26
| Professional | | $305.20 | $570.36 | $722.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.18 / $230.73 / $392.05
| Professional | | $148.18 | $230.73 | $392.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.06 / $253.23 / $522.25
| Professional | | $150.06 | $253.23 | $522.25 |