- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.74 / $243.36 / $393.69
| Professional | | $120.74 | $243.36 | $393.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.40 / $260.18 / $439.95
| Professional | | $141.40 | $260.18 | $439.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.54 / $162.83 / $226.42
| Professional | | $25.54 | $162.83 | $226.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.44 / $258.02 / $431.16
| Professional | | $177.44 | $258.02 | $431.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.80 / $284.69 / $516.95
| Professional | | $226.80 | $284.69 | $516.95 |