- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.13 / $205.82 / $292.54
| Professional | | $135.13 | $205.82 | $292.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.16 / $227.45 / $361.42
| Professional | | $41.16 | $227.45 | $361.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.84 / $197.47 / $348.46
| Professional | | $101.84 | $197.47 | $348.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.16 / $236.75 / $314.88
| Professional | | $168.16 | $236.75 | $314.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.28 / $184.90 / $283.03
| Professional | | $32.28 | $184.90 | $283.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.73 / $281.10 / $381.86
| Professional | | $227.73 | $281.10 | $381.86 |