- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.19 / $180.44 / $228.66
| Professional | | $158.19 | $180.44 | $228.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.84 / $226.51 / $471.59
| Professional | | $183.84 | $226.51 | $471.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.96 / $147.62 / $185.53
| Professional | | $115.96 | $147.62 | $185.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.70 / $216.33 / $258.12
| Professional | | $194.70 | $216.33 | $258.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.82 / $170.45 / $248.38
| Professional | | $131.82 | $170.45 | $248.38 |