- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.47 / $210.57 / $428.29
| Professional | | $133.47 | $210.57 | $428.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.59 / $150.16 / $225.24
| Professional | | $126.59 | $150.16 | $225.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.88 / $228.50 / $384.98
| Professional | | $140.88 | $228.50 | $384.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.48 / $294.75 / $1,727.36
| Professional | | $204.48 | $294.75 | $1,727.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.93 / $248.90 / $466.12
| Professional | | $200.93 | $248.90 | $466.12 |