- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.68 / $180.91 / $217.69
| Professional | | $135.68 | $180.91 | $217.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.94 / $177.09 / $293.82
| Professional | | $144.94 | $177.09 | $293.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $104.31 / $127.21
| Professional | | $60.00 | $104.31 | $127.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.37 / $292.37 / $324.83
| Professional | | $292.37 | $292.37 | $324.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.90 / $180.25 / $283.25
| Professional | | $156.90 | $180.25 | $283.25 |