- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.63 / $205.26 / $297.61
| Professional | | $142.63 | $205.26 | $297.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.85 / $257.26 / $434.23
| Professional | | $151.85 | $257.26 | $434.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.09 / $168.84 / $268.82
| Professional | | $107.09 | $168.84 | $268.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.14 / $201.94 / $323.10
| Professional | | $32.14 | $201.94 | $323.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.13 / $253.13 / $473.43
| Professional | | $179.13 | $253.13 | $473.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.30 / $195.07 / $195.07
| Professional | | $122.30 | $195.07 | $195.07 |