- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.97 / $194.87 / $293.62
| Professional | | $130.97 | $194.87 | $293.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.38 / $215.10 / $274.70
| Professional | | $157.38 | $215.10 | $274.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.47 / $219.96 / $320.88
| Professional | | $181.47 | $219.96 | $320.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $227.83 / $286.63
| Professional | | $32.34 | $227.83 | $286.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.42 / $210.68 / $314.33
| Professional | | $174.42 | $210.68 | $314.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.97 / $194.85 / $307.43
| Professional | | $140.97 | $194.85 | $307.43 |