- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.35 / $211.53 / $348.88
| Professional | | $141.35 | $211.53 | $348.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.50 / $227.54 / $325.74
| Professional | | $166.50 | $227.54 | $325.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.80 / $236.12 / $380.40
| Professional | | $194.80 | $236.12 | $380.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $268.93 / $338.33
| Professional | | $32.34 | $268.93 | $338.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.21 / $228.34 / $374.31
| Professional | | $187.21 | $228.34 | $374.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.50 / $210.59 / $317.48
| Professional | | $143.50 | $210.59 | $317.48 |