- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.52 / $208.34 / $283.92
| Professional | | $155.52 | $208.34 | $283.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.71 / $215.13 / $300.37
| Professional | | $152.71 | $215.13 | $300.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.48 / $313.77 / $374.55
| Professional | | $261.48 | $313.77 | $374.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.18 / $265.25 / $430.46
| Professional | | $193.18 | $265.25 | $430.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.22 / $282.43 / $479.38
| Professional | | $213.22 | $282.43 | $479.38 |