- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.78 / $180.43 / $309.87
| Professional | | $126.78 | $180.43 | $309.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.63 / $163.41 / $273.57
| Professional | | $121.63 | $163.41 | $273.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.46 / $233.41 / $485.50
| Professional | | $140.46 | $233.41 | $485.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.25 / $188.61 / $587.41
| Professional | | $68.25 | $188.61 | $587.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.82 / $207.15 / $343.13
| Professional | | $31.82 | $207.15 | $343.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.89 / $240.48 / $468.59
| Professional | | $181.89 | $240.48 | $468.59 |