- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.86 / $227.05 / $324.74
| Professional | | $139.86 | $227.05 | $324.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.56 / $170.30 / $285.14
| Professional | | $115.56 | $170.30 | $285.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.07 / $193.26 / $341.42
| Professional | | $148.07 | $193.26 | $341.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.88 / $238.22 / $412.81
| Professional | | $150.88 | $238.22 | $412.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $258.80
| Professional | | $32.34 | $32.34 | $258.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.87 / $278.95 / $457.73
| Professional | | $205.87 | $278.95 | $457.73 |