- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.18 / $184.61 / $286.35
| Professional | | $159.18 | $184.61 | $286.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.82 / $270.38 / $316.95
| Professional | | $109.82 | $270.38 | $316.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.69 / $190.24 / $325.92
| Professional | | $138.69 | $190.24 | $325.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.15 / $173.15 / $191.25
| Professional | | $173.15 | $173.15 | $191.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.17 / $183.41 / $361.43
| Professional | | $120.17 | $183.41 | $361.43 |