- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.20 / $180.63 / $309.87
| Professional | | $125.20 | $180.63 | $309.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.08 / $151.13 / $239.53
| Professional | | $103.08 | $151.13 | $239.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.84 / $271.01 / $338.76
| Professional | | $225.84 | $271.01 | $338.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.54 / $220.60 / $399.29
| Professional | | $134.54 | $220.60 | $399.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.10 / $235.24 / $425.68
| Professional | | $174.10 | $235.24 | $425.68 |