- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.72 / $179.75 / $246.53
| Professional | | $134.72 | $179.75 | $246.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.92 / $241.51 / $739.58
| Professional | | $198.92 | $241.51 | $739.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.43 / $198.68 / $505.79
| Professional | | $145.43 | $198.68 | $505.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.24 / $253.59 / $505.79
| Professional | | $181.24 | $253.59 | $505.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.87 / $224.19 / $708.81
| Professional | | $182.87 | $224.19 | $708.81 |