- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.91 / $254.71 / $467.56
| Professional | | $130.91 | $254.71 | $467.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.60 / $254.29 / $301.70
| Professional | | $128.60 | $254.29 | $301.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.67 / $321.20 / $618.55
| Professional | | $164.67 | $321.20 | $618.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.54 / $442.30 / $442.30
| Professional | | $321.54 | $442.30 | $442.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.12 / $397.28 / $715.29
| Professional | | $259.12 | $397.28 | $715.29 |