- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.40 / $146.52 / $218.83
| Professional | | $113.40 | $146.52 | $218.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.05 / $308.02 / $492.28
| Professional | | $288.05 | $308.02 | $492.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.67 / $202.42 / $236.23
| Professional | | $119.67 | $202.42 | $236.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.67 / $196.24 / $235.21
| Professional | | $119.67 | $196.24 | $235.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.28 / $181.18 / $549.60
| Professional | | $152.28 | $181.18 | $549.60 |