- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.84 / $154.54 / $194.99
| Professional | | $123.84 | $154.54 | $194.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.46 / $182.74 / $224.05
| Professional | | $168.46 | $182.74 | $224.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.00 / $200.00 / $715.05
| Professional | | $117.00 | $200.00 | $715.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.72 / $164.58 / $431.14
| Professional | | $133.72 | $164.58 | $431.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.08 / $190.23 / $545.97
| Professional | | $113.08 | $190.23 | $545.97 |