- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.62 / $230.35 / $331.40
| Professional | | $145.62 | $230.35 | $331.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.54 / $178.91 / $375.70
| Professional | | $40.54 | $178.91 | $375.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.18 / $227.27 / $450.95
| Professional | | $151.18 | $227.27 | $450.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.62 / $255.32 / $413.91
| Professional | | $207.62 | $255.32 | $413.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.69 / $192.46 / $289.27
| Professional | | $30.69 | $192.46 | $289.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.64 / $292.58 / $404.22
| Professional | | $238.64 | $292.58 | $404.22 |