- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $213.80 / $371.54
| Professional | | $138.04 | $213.80 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $223.87 / $346.74
| Professional | | $128.82 | $223.87 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $263.03 / $398.11
| Professional | | $162.18 | $263.03 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $263.03 / $407.38
| Professional | | $144.54 | $263.03 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $251.19 / $588.84
| Professional | | $154.88 | $251.19 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $257.04 / $407.38
| Professional | | $147.91 | $257.04 | $407.38 |