- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.79 / $165.63 / $214.49
| Professional | | $156.79 | $165.63 | $214.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.88 / $288.66 / $643.04
| Professional | | $244.88 | $288.66 | $643.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.55 / $243.19 / $399.54
| Professional | | $173.55 | $243.19 | $399.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.12 / $246.67 / $399.54
| Professional | | $182.12 | $246.67 | $399.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.85 / $246.85 / $729.49
| Professional | | $206.85 | $246.85 | $729.49 |