- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $177.83 / $398.11
| Professional | | $141.25 | $177.83 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Professional | | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $229.09 / $524.81
| Professional | | $147.91 | $229.09 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $239.88 / $331.13
| Professional | | $162.18 | $239.88 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $208.93 / $645.65
| Professional | | $128.82 | $208.93 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $177.83 / $426.58
| Professional | | $123.03 | $177.83 | $426.58 |