- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.37 / $186.05 / $536.83
| Professional | | $91.37 | $186.05 | $536.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.60 / $173.80 / $307.39
| Professional | | $122.60 | $173.80 | $307.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.16 / $188.75 / $337.06
| Professional | | $145.16 | $188.75 | $337.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $239.40 / $301.18
| Professional | | $32.34 | $239.40 | $301.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.85 / $205.56 / $354.58
| Professional | | $168.85 | $205.56 | $354.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.19 / $211.60 / $315.14
| Professional | | $156.19 | $211.60 | $315.14 |