- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.19 / $165.94 / $373.15
| Professional | | $117.19 | $165.94 | $373.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.79 / $237.55 / $365.22
| Professional | | $135.79 | $237.55 | $365.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.03 / $297.45 / $513.96
| Professional | | $136.03 | $297.45 | $513.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.46 / $239.97 / $378.15
| Professional | | $121.46 | $239.97 | $378.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.19 / $165.94 / $373.15
| Professional | | $117.19 | $165.94 | $373.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.71 / $289.22 / $414.11
| Professional | | $184.71 | $289.22 | $414.11 |