- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.78 / $214.57 / $341.87
| Professional | | $126.78 | $214.57 | $341.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.98 / $160.47 / $297.64
| Professional | | $91.98 | $160.47 | $297.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.59 / $251.86 / $297.64
| Professional | | $153.59 | $251.86 | $297.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.58 / $237.30 / $419.66
| Professional | | $136.58 | $237.30 | $419.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.30 / $246.42 / $412.12
| Professional | | $141.30 | $246.42 | $412.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.24 / $204.02 / $317.82
| Professional | | $32.24 | $204.02 | $317.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.10 / $255.75 / $465.88
| Professional | | $179.10 | $255.75 | $465.88 |