- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.85 / $256.75 / $934.05
| Professional | | $164.85 | $256.75 | $934.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.88 / $212.12 / $306.55
| Professional | | $190.88 | $212.12 | $306.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.69 / $282.76 / $446.33
| Professional | | $171.69 | $282.76 | $446.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.41 / $269.97 / $736.10
| Professional | | $1.41 | $269.97 | $736.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.96 / $234.08 / $1,162.26
| Professional | | $0.96 | $234.08 | $1,162.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.39 / $302.02 / $465.87
| Professional | | $229.39 | $302.02 | $465.87 |