- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.07 / $185.09 / $300.14
| Professional | | $160.07 | $185.09 | $300.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.26 / $255.72 / $311.81
| Professional | | $121.26 | $255.72 | $311.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.47 / $186.63 / $379.78
| Professional | | $148.47 | $186.63 | $379.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.82 / $199.58 / $199.58
| Professional | | $167.82 | $199.58 | $199.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.85 / $209.35 / $365.71
| Professional | | $124.85 | $209.35 | $365.71 |