- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.74 / $147.85 / $362.47
| Professional | | $129.74 | $147.85 | $362.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.69 / $153.01 / $245.64
| Professional | | $143.69 | $153.01 | $245.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.96 / $197.79 / $380.26
| Professional | | $133.96 | $197.79 | $380.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.96 / $141.01 / $310.27
| Professional | | $133.96 | $141.01 | $310.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.86 / $166.14 / $348.93
| Professional | | $124.86 | $166.14 | $348.93 |