- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.85 / $163.80 / $280.36
| Professional | | $139.85 | $163.80 | $280.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.40 / $181.40 / $181.40
| Professional | | $181.40 | $181.40 | $181.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.66 / $235.53 / $516.04
| Professional | | $153.66 | $235.53 | $516.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.81 / $239.35 / $300.33
| Professional | | $161.81 | $239.35 | $300.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.26 / $206.35 / $380.21
| Professional | | $141.26 | $206.35 | $380.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.54 / $213.39 / $539.28
| Professional | | $149.54 | $213.39 | $539.28 |