- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.64 / $206.12 / $206.12
| Professional | | $178.64 | $206.12 | $206.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.86 / $247.35 / $281.98
| Professional | | $219.86 | $247.35 | $281.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.66 / $145.66 / $145.66
| Professional | | $145.66 | $145.66 | $145.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.83 / $329.80 / $412.25
| Professional | | $274.83 | $329.80 | $412.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.43 / $123.67 / $241.85
| Professional | | $115.43 | $123.67 | $241.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.41 / $218.49 / $218.49
| Professional | | $137.41 | $218.49 | $218.49 |