- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.94 / $217.27 / $266.44
| Professional | | $162.94 | $217.27 | $266.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.10 / $214.43 / $415.60
| Professional | | $173.10 | $214.43 | $415.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $155.59 / $189.74
| Professional | | $60.00 | $155.59 | $189.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.47 / $352.47 / $391.65
| Professional | | $352.47 | $352.47 | $391.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.90 / $213.18 / $344.85
| Professional | | $191.90 | $213.18 | $344.85 |