- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.64 / $135.30 / $185.39
| Professional | | $106.64 | $135.30 | $185.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.99 / $278.48 / $306.35
| Professional | | $228.99 | $278.48 | $306.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.86 / $256.30 / $400.51
| Professional | | $116.86 | $256.30 | $400.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.41 / $224.22 / $880.77
| Professional | | $136.41 | $224.22 | $880.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.41 / $224.22 / $320.95
| Professional | | $136.41 | $224.22 | $320.95 |