- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.52 / $208.34 / $507.45
| Professional | | $155.52 | $208.34 | $507.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.57 / $311.52 / $451.24
| Professional | | $222.57 | $311.52 | $451.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.65 / $180.85 / $254.72
| Professional | | $25.65 | $180.85 | $254.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.01 / $318.77 / $432.76
| Professional | | $207.01 | $318.77 | $432.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.84 / $296.92 / $481.98
| Professional | | $238.84 | $296.92 | $481.98 |