- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.87 / $170.10 / $271.20
| Professional | | $105.87 | $170.10 | $271.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.48 / $226.86 / $406.55
| Professional | | $127.48 | $226.86 | $406.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.75 / $171.49 / $306.52
| Professional | | $150.75 | $171.49 | $306.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.28 / $176.49 / $299.65
| Professional | | $32.28 | $176.49 | $299.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.96 / $264.01 / $477.27
| Professional | | $172.96 | $264.01 | $477.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.41 / $188.94 / $188.94
| Professional | | $103.41 | $188.94 | $188.94 |