- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.82 / $181.38 / $240.14
| Professional | | $119.82 | $181.38 | $240.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.52 / $248.34 / $448.62
| Professional | | $145.52 | $248.34 | $448.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.26 / $224.26 / $224.26
| Professional | | $224.26 | $224.26 | $224.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.52 / $175.18 / $267.83
| Professional | | $136.52 | $175.18 | $267.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.36 / $234.43 / $356.42
| Professional | | $165.36 | $234.43 | $356.42 |