- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.09 / $174.89 / $298.02
| Professional | | $114.09 | $174.89 | $298.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.40 / $221.41 / $404.47
| Professional | | $129.40 | $221.41 | $404.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.25 / $176.52 / $281.19
| Professional | | $84.25 | $176.52 | $281.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.31 / $195.72 / $308.19
| Professional | | $31.31 | $195.72 | $308.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.80 / $232.18 / $428.42
| Professional | | $158.80 | $232.18 | $428.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.34 / $159.26 / $159.26
| Professional | | $100.34 | $159.26 | $159.26 |