- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.72 / $216.34 / $307.64
| Professional | | $154.72 | $216.34 | $307.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.04 / $259.26 / $343.02
| Professional | | $128.04 | $259.26 | $343.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.99 / $200.64 / $379.47
| Professional | | $157.99 | $200.64 | $379.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.08 / $241.05 / $241.05
| Professional | | $197.08 | $241.05 | $241.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.88 / $262.51 / $430.74
| Professional | | $146.88 | $262.51 | $430.74 |