- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.74 / $133.44 / $187.41
| Professional | | $125.74 | $133.44 | $187.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.06 / $225.01 / $346.27
| Professional | | $124.06 | $225.01 | $346.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.71 / $134.52 / $260.92
| Professional | | $117.71 | $134.52 | $260.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.17 / $156.45 / $279.73
| Professional | | $36.17 | $156.45 | $279.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.83 / $171.21 / $336.11
| Professional | | $147.83 | $171.21 | $336.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.05 / $138.05 / $138.05
| Professional | | $138.05 | $138.05 | $138.05 |