- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $173.78 / $346.74
| Professional | | $128.82 | $173.78 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $165.96 / $194.98
| Professional | | $141.25 | $165.96 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $177.83 / $251.19
| Professional | | $131.83 | $177.83 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $190.55 / $354.81
| Professional | | $147.91 | $190.55 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $177.83 / $309.03
| Professional | | $128.82 | $177.83 | $309.03 |