- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.63 / $221.75 / $313.23
| Professional | | $157.63 | $221.75 | $313.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.18 / $280.51 / $472.47
| Professional | | $168.18 | $280.51 | $472.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.80 / $235.93 / $289.37
| Professional | | $114.80 | $235.93 | $289.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.48 / $228.70 / $360.50
| Professional | | $33.48 | $228.70 | $360.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.20 / $273.30 / $507.71
| Professional | | $196.20 | $273.30 | $507.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.34 / $209.37 / $209.37
| Professional | | $136.34 | $209.37 | $209.37 |