- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.28 / $276.82 / $393.57
| Professional | | $167.28 | $276.82 | $393.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.55 / $195.27 / $301.89
| Professional | | $156.55 | $195.27 | $301.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.09 / $259.57 / $461.74
| Professional | | $202.09 | $259.57 | $461.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.26 / $361.05 / $629.45
| Professional | | $227.26 | $361.05 | $629.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $389.78
| Professional | | $32.34 | $32.34 | $389.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.39 / $412.32 / $632.36
| Professional | | $290.39 | $412.32 | $632.36 |