- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $149.97 / $158.47
| Professional | | $107.15 | $149.97 | $158.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.53 / $170.38 / $481.61
| Professional | | $144.53 | $170.38 | $481.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.44 / $198.35 / $287.14
| Professional | | $144.44 | $198.35 | $287.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.36 / $189.02 / $287.14
| Professional | | $132.36 | $189.02 | $287.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.16 / $180.35 / $524.28
| Professional | | $168.16 | $180.35 | $524.28 |