- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.06 / $200.62 / $341.54
| Professional | | $165.06 | $200.62 | $341.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.43 / $315.55 / $632.86
| Professional | | $150.43 | $315.55 | $632.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $297.13 / $346.41
| Professional | | $213.80 | $297.13 | $346.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.90 / $219.57 / $418.29
| Professional | | $154.90 | $219.57 | $418.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.02 / $188.69 / $395.29
| Professional | | $140.02 | $188.69 | $395.29 |