- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $128.82 / $257.04
| Professional | | $97.72 | $128.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $275.42 / $354.81
| Professional | | $204.17 | $275.42 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $251.19 / $389.05
| Professional | | $134.90 | $251.19 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $257.04 / $1,071.52
| Professional | | $144.54 | $257.04 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $208.93 / $309.03
| Professional | | $123.03 | $208.93 | $309.03 |