- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.64 / $118.95 / $362.51
| Professional | | $94.64 | $118.95 | $362.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.56 / $206.73 / $299.75
| Professional | | $145.56 | $206.73 | $299.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.66 / $288.27 / $444.47
| Professional | | $191.66 | $288.27 | $444.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.71 / $317.48 / $556.72
| Professional | | $166.71 | $317.48 | $556.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.62 / $163.65 / $510.80
| Professional | | $125.62 | $163.65 | $510.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.24 / $118.25 / $178.59
| Professional | | $101.24 | $118.25 | $178.59 |