- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $112.20 / $186.21
| Professional | | $77.62 | $112.20 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $245.47 / $436.52
| Professional | | $151.36 | $245.47 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $309.03 / $537.03
| Professional | | $177.83 | $309.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $281.84 / $512.86
| Professional | | $186.21 | $281.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $229.09 / $630.96
| Professional | | $114.82 | $229.09 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $177.83 / $363.08
| Professional | | $97.72 | $177.83 | $363.08 |