- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.78 / $268.52 / $373.38
| Professional | | $180.78 | $268.52 | $373.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.85 / $321.36 / $580.89
| Professional | | $223.85 | $321.36 | $580.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.68 / $174.43 / $243.50
| Professional | | $100.68 | $174.43 | $243.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.81 / $218.49 / $346.67
| Professional | | $38.81 | $218.49 | $346.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.02 / $256.49 / $482.77
| Professional | | $178.02 | $256.49 | $482.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.28 / $193.28 / $208.98
| Professional | | $193.28 | $193.28 | $208.98 |