- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.93 / $155.25 / $354.67
| Professional | | $115.93 | $155.25 | $354.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.27 / $238.76 / $329.90
| Professional | | $128.27 | $238.76 | $329.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.58 / $255.93 / $384.01
| Professional | | $169.58 | $255.93 | $384.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.82 / $210.20 / $276.02
| Professional | | $130.82 | $210.20 | $276.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.82 / $281.19 / $438.70
| Professional | | $136.82 | $281.19 | $438.70 |