- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.19 / $172.10 / $275.61
| Professional | | $129.19 | $172.10 | $275.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.08 / $183.63 / $266.98
| Professional | | $156.08 | $183.63 | $266.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.06 / $266.94 / $454.93
| Professional | | $165.06 | $266.94 | $454.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.36 / $292.66 / $475.13
| Professional | | $174.36 | $292.66 | $475.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.41 / $172.10 / $275.61
| Professional | | $135.41 | $172.10 | $275.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.00 / $285.20 / $466.53
| Professional | | $191.00 | $285.20 | $466.53 |