- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.79 / $157.88 / $359.55
| Professional | | $123.79 | $157.88 | $359.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.02 / $202.01 / $225.53
| Professional | | $165.02 | $202.01 | $225.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.27 / $214.49 / $225.78
| Professional | | $186.27 | $214.49 | $225.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $186.27
| Professional | | $32.34 | $32.34 | $186.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.11 / $233.28 / $233.28
| Professional | | $221.11 | $233.28 | $233.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.57 / $167.50 / $261.79
| Professional | | $95.57 | $167.50 | $261.79 |