- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.07 / $188.43 / $307.89
| Professional | | $144.07 | $188.43 | $307.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.35 / $272.57 / $474.64
| Professional | | $171.35 | $272.57 | $474.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.51 / $384.35 / $769.13
| Professional | | $200.51 | $384.35 | $769.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.22 / $367.75 / $826.38
| Professional | | $176.22 | $367.75 | $826.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.09 / $397.58 / $715.56
| Professional | | $245.09 | $397.58 | $715.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.78 / $184.02 / $275.97
| Professional | | $122.78 | $184.02 | $275.97 |