- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.19 / $247.26 / $355.46
| Professional | | $166.19 | $247.26 | $355.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.52 / $241.75 / $450.75
| Professional | | $50.52 | $241.75 | $450.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.87 / $261.14 / $479.57
| Professional | | $168.87 | $261.14 | $479.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.44 / $271.50 / $416.17
| Professional | | $230.44 | $271.50 | $416.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.06 / $216.54 / $328.36
| Professional | | $32.06 | $216.54 | $328.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.32 / $316.17 / $433.77
| Professional | | $258.32 | $316.17 | $433.77 |