- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.80 / $181.64 / $212.04
| Professional | | $130.80 | $181.64 | $212.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.83 / $273.27 / $658.80
| Professional | | $231.83 | $273.27 | $658.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.25 / $277.98 / $405.95
| Professional | | $175.25 | $277.98 | $405.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.21 / $262.08 / $405.95
| Professional | | $200.21 | $262.08 | $405.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.62 / $254.97 / $741.21
| Professional | | $198.62 | $254.97 | $741.21 |