- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.36 / $208.82 / $279.57
| Professional | | $145.36 | $208.82 | $279.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.07 / $263.06 / $439.28
| Professional | | $167.07 | $263.06 | $439.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.28 / $212.20 / $332.01
| Professional | | $135.28 | $212.20 | $332.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.07 / $206.59 / $328.18
| Professional | | $31.07 | $206.59 | $328.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.35 / $263.18 / $445.02
| Professional | | $195.35 | $263.18 | $445.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.28 / $221.62 / $221.62
| Professional | | $145.28 | $221.62 | $221.62 |