- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.29 / $223.88 / $270.39
| Professional | | $150.29 | $223.88 | $270.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.88 / $197.77 / $291.50
| Professional | | $162.88 | $197.77 | $291.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.81 / $252.52 / $516.66
| Professional | | $157.81 | $252.52 | $516.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.87 / $278.86 / $492.66
| Professional | | $193.87 | $278.86 | $492.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $335.83
| Professional | | $32.34 | $32.34 | $335.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.93 / $290.56 / $475.42
| Professional | | $225.93 | $290.56 | $475.42 |