- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.62 / $152.55 / $325.70
| Professional | | $146.62 | $152.55 | $325.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.75 / $241.31 / $739.48
| Professional | | $198.75 | $241.31 | $739.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.68 / $207.30 / $520.91
| Professional | | $144.68 | $207.30 | $520.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.84 / $212.00 / $520.91
| Professional | | $143.84 | $212.00 | $520.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.29 / $165.53 / $557.54
| Professional | | $123.29 | $165.53 | $557.54 |