- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $134.90 / $223.87
| Professional | | $97.72 | $134.90 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $288.40 / $501.19
| Professional | | $181.97 | $288.40 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $363.08 / $616.60
| Professional | | $218.78 | $363.08 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $346.74 / $575.44
| Professional | | $229.09 | $346.74 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $275.42 / $776.25
| Professional | | $141.25 | $275.42 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $218.78 / $436.52
| Professional | | $123.03 | $218.78 | $436.52 |