- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.80 / $173.80 / $381.11
| Professional | | $130.80 | $173.80 | $381.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.08 / $282.89 / $390.88
| Professional | | $145.08 | $282.89 | $390.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.59 / $285.47 / $442.62
| Professional | | $206.59 | $285.47 | $442.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.07 / $235.07 / $313.10
| Professional | | $161.07 | $235.07 | $313.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.69 / $311.42 / $546.70
| Professional | | $159.69 | $311.42 | $546.70 |