- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.64 / $232.83 / $652.44
| Professional | | $110.64 | $232.83 | $652.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.27 / $209.51 / $375.34
| Professional | | $134.27 | $209.51 | $375.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.19 / $235.85 / $421.16
| Professional | | $177.19 | $235.85 | $421.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $337.16
| Professional | | $32.34 | $32.34 | $337.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.48 / $250.99 / $441.89
| Professional | | $205.48 | $250.99 | $441.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.76 / $309.75 / $513.91
| Professional | | $218.76 | $309.75 | $513.91 |