- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.96 / $173.44 / $477.88
| Professional | | $97.96 | $173.44 | $477.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.49 / $161.49 / $190.36
| Professional | | $161.49 | $161.49 | $190.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.48 / $155.16 / $459.65
| Professional | | $122.48 | $155.16 | $459.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.72 / $183.50 / $459.65
| Professional | | $148.72 | $183.50 | $459.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.78 / $169.93 / $564.16
| Professional | | $140.78 | $169.93 | $564.16 |