- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.22 / $208.20 / $294.08
| Professional | | $147.22 | $208.20 | $294.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.75 / $261.45 / $448.02
| Professional | | $155.75 | $261.45 | $448.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.90 / $221.07 / $272.74
| Professional | | $107.90 | $221.07 | $272.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.14 / $202.63 / $323.38
| Professional | | $32.14 | $202.63 | $323.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.92 / $253.72 / $453.75
| Professional | | $185.92 | $253.72 | $453.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.13 / $197.88 / $197.88
| Professional | | $126.13 | $197.88 | $197.88 |