- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.97 / $123.74 / $195.44
| Professional | | $83.97 | $123.74 | $195.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.90 / $277.14 / $448.12
| Professional | | $161.90 | $277.14 | $448.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.66 / $307.61 / $540.97
| Professional | | $182.66 | $307.61 | $540.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.06 / $285.89 / $493.28
| Professional | | $184.06 | $285.89 | $493.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.18 / $245.58 / $647.20
| Professional | | $134.18 | $245.58 | $647.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.00 / $231.76 / $457.09
| Professional | | $134.00 | $231.76 | $457.09 |