- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.63 / $256.75 / $934.05
| Professional | | $159.63 | $256.75 | $934.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.72 / $301.01 / $506.01
| Professional | | $207.72 | $301.01 | $506.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.68 / $185.41 / $254.26
| Professional | | $27.68 | $185.41 | $254.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.94 / $395.58 / $614.04
| Professional | | $232.94 | $395.58 | $614.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.94 / $284.76 / $460.73
| Professional | | $232.94 | $284.76 | $460.73 |