- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.79 / $204.35 / $415.08
| Professional | | $135.79 | $204.35 | $415.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.25 / $271.33 / $385.57
| Professional | | $183.25 | $271.33 | $385.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.85 / $314.00 / $507.01
| Professional | | $187.85 | $314.00 | $507.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.22 / $315.99 / $526.73
| Professional | | $210.22 | $315.99 | $526.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.78 / $207.69 / $415.08
| Professional | | $135.78 | $207.69 | $415.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.50 / $350.96 / $573.23
| Professional | | $243.50 | $350.96 | $573.23 |