- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.94 / $192.01 / $235.31
| Professional | | $129.94 | $192.01 | $235.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.25 / $237.06 / $726.45
| Professional | | $195.25 | $237.06 | $726.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.57 / $204.93 / $547.13
| Professional | | $131.57 | $204.93 | $547.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.11 / $278.08 / $547.13
| Professional | | $176.11 | $278.08 | $547.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.75 / $266.33 / $774.26
| Professional | | $199.75 | $266.33 | $774.26 |