- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.91 / $173.20 / $261.64
| Professional | | $134.91 | $173.20 | $261.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.36 / $323.39 / $987.28
| Professional | | $266.36 | $323.39 | $987.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.86 / $180.95 / $491.05
| Professional | | $106.86 | $180.95 | $491.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.19 / $221.24 / $491.05
| Professional | | $143.19 | $221.24 | $491.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.77 / $225.02 / $654.16
| Professional | | $168.77 | $225.02 | $654.16 |