- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.98 / $131.94 / $169.56
| Professional | | $93.98 | $131.94 | $169.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.86 / $263.89 / $463.13
| Professional | | $223.86 | $263.89 | $463.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.49 / $191.62 / $292.95
| Professional | | $129.49 | $191.62 | $292.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.88 / $190.25 / $292.95
| Professional | | $139.88 | $190.25 | $292.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.75 / $194.84 / $534.91
| Professional | | $177.75 | $194.84 | $534.91 |