- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.54 / $225.28 / $400.38
| Professional | | $146.54 | $225.28 | $400.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.82 / $176.93 / $187.55
| Professional | | $139.82 | $176.93 | $187.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.88 / $266.30 / $541.66
| Professional | | $158.88 | $266.30 | $541.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.93 / $341.51 / $456.70
| Professional | | $262.93 | $341.51 | $456.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.51 / $288.20 / $533.44
| Professional | | $193.51 | $288.20 | $533.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.91 / $304.45 / $375.62
| Professional | | $152.91 | $304.45 | $375.62 |