- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.31 / $198.90 / $260.16
| Professional | | $149.31 | $198.90 | $260.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.71 / $174.70 / $265.66
| Professional | | $124.71 | $174.70 | $265.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.94 / $204.13 / $321.64
| Professional | | $142.94 | $204.13 | $321.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.44 / $222.58 / $385.89
| Professional | | $155.44 | $222.58 | $385.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $209.98
| Professional | | $32.34 | $32.34 | $209.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.11 / $242.17 / $395.57
| Professional | | $184.11 | $242.17 | $395.57 |