- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.40 / $220.72 / $303.76
| Professional | | $115.40 | $220.72 | $303.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.38 / $320.49 / $751.95
| Professional | | $140.38 | $320.49 | $751.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.55 / $409.23 / $502.48
| Professional | | $249.55 | $409.23 | $502.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.46 / $254.32 / $430.53
| Professional | | $106.46 | $254.32 | $430.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.12 / $268.87 / $580.98
| Professional | | $203.12 | $268.87 | $580.98 |