- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $239.88 / $457.09
| Professional | | $75.86 | $239.88 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $263.03 / $524.81
| Professional | | $89.13 | $263.03 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $251.19 / $446.68
| Professional | | $97.72 | $251.19 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $331.13 / $549.54
| Professional | | $79.43 | $331.13 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $436.52 / $512.86
| Professional | | $117.49 | $436.52 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $316.23 / $346.74
| Professional | | $79.43 | $316.23 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $275.42 / $489.78
| Professional | | $97.72 | $275.42 | $489.78 |