- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.77 / $184.69 / $508.12
| Professional | | $128.77 | $184.69 | $508.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.26 / $338.77 / $482.12
| Professional | | $136.26 | $338.77 | $482.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.37 / $236.94 / $371.31
| Professional | | $152.37 | $236.94 | $371.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.41 / $197.57 / $288.12
| Professional | | $150.41 | $197.57 | $288.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.30 / $190.80 / $314.79
| Professional | | $128.30 | $190.80 | $314.79 |