- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.52 / $184.19 / $301.38
| Professional | | $137.52 | $184.19 | $301.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.69 / $257.20 / $324.97
| Professional | | $135.69 | $257.20 | $324.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.00 / $212.46 / $386.06
| Professional | | $169.00 | $212.46 | $386.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.69 / $275.72 / $275.72
| Professional | | $203.69 | $275.72 | $275.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.43 / $226.75 / $443.76
| Professional | | $168.43 | $226.75 | $443.76 |