- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.84 / $187.75 / $417.68
| Professional | | $92.84 | $187.75 | $417.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.21 / $220.26 / $327.16
| Professional | | $121.21 | $220.26 | $327.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.58 / $370.20 / $746.41
| Professional | | $175.58 | $370.20 | $746.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.53 / $389.14 / $897.86
| Professional | | $156.53 | $389.14 | $897.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.82 / $476.59 / $862.42
| Professional | | $318.82 | $476.59 | $862.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.34 / $176.79 / $284.87
| Professional | | $93.34 | $176.79 | $284.87 |