- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.87 / $156.97 / $193.72
| Professional | | $126.87 | $156.97 | $193.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.76 / $145.50 / $215.59
| Professional | | $98.76 | $145.50 | $215.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.91 / $194.85 / $302.36
| Professional | | $159.91 | $194.85 | $302.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.76 / $188.78 / $331.67
| Professional | | $139.76 | $188.78 | $331.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.44 / $204.47 / $328.70
| Professional | | $144.44 | $204.47 | $328.70 |