- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $239.88 / $1,071.52
| Professional | | $32.36 | $239.88 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $309.03 / $446.68
| Professional | | $204.17 | $309.03 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $239.88 / $575.44
| Professional | | $177.83 | $239.88 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $60.26 / $75.86
| Professional | | $45.71 | $60.26 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $363.08 / $707.95
| Professional | | $38.90 | $363.08 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $60.26 / $81.28
| Professional | | $46.77 | $60.26 | $81.28 |