- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.70 / $246.65 / $360.85
| Professional | | $187.70 | $246.65 | $360.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.30 / $331.94 / $570.05
| Professional | | $192.30 | $331.94 | $570.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.44 / $207.43 / $372.10
| Professional | | $197.44 | $207.43 | $372.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.59 / $243.69 / $387.73
| Professional | | $32.59 | $243.69 | $387.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.62 / $384.71 / $726.60
| Professional | | $259.62 | $384.71 | $726.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.02 / $228.52 / $228.52
| Professional | | $157.02 | $228.52 | $228.52 |