- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.35 / $172.73 / $200.75
| Professional | | $158.35 | $172.73 | $200.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.16 / $224.31 / $368.21
| Professional | | $187.16 | $224.31 | $368.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.29 / $269.11 / $406.84
| Professional | | $161.29 | $269.11 | $406.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.72 / $261.08 / $1,317.18
| Professional | | $171.72 | $261.08 | $1,317.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.72 / $245.11 / $397.70
| Professional | | $171.72 | $245.11 | $397.70 |