- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.50 / $214.19 / $374.87
| Professional | | $107.50 | $214.19 | $374.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.06 / $233.87 / $474.88
| Professional | | $132.06 | $233.87 | $474.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.94 / $241.24 / $531.05
| Professional | | $127.94 | $241.24 | $531.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.25 / $303.58 / $436.04
| Professional | | $146.25 | $303.58 | $436.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.98 / $308.45 / $845.75
| Professional | | $180.98 | $308.45 | $845.75 |