- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $141.25 / $234.42
| Professional | | $125.89 | $141.25 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $295.12 / $331.13
| Professional | | $223.87 | $295.12 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $281.84 / $436.52
| Professional | | $194.98 | $281.84 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $288.40 / $1,778.28
| Professional | | $144.54 | $288.40 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $269.15 / $354.81
| Professional | | $144.54 | $269.15 | $354.81 |