- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.91 / $184.67 / $232.93
| Professional | | $138.91 | $184.67 | $232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.44 / $148.87 / $218.28
| Professional | | $124.44 | $148.87 | $218.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.24 / $205.58 / $329.81
| Professional | | $161.24 | $205.58 | $329.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.19 / $247.22 / $401.56
| Professional | | $165.19 | $247.22 | $401.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $262.08
| Professional | | $32.34 | $32.34 | $262.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.54 / $253.28 / $403.05
| Professional | | $188.54 | $253.28 | $403.05 |