- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.63 / $225.66 / $320.13
| Professional | | $129.63 | $225.66 | $320.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.69 / $171.88 / $258.64
| Professional | | $125.69 | $171.88 | $258.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.41 / $204.73 / $324.77
| Professional | | $137.41 | $204.73 | $324.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.51 / $214.72 / $280.20
| Professional | | $172.51 | $214.72 | $280.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.56 / $229.71 / $428.47
| Professional | | $173.56 | $229.71 | $428.47 |