- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $190.55 / $275.42
| Professional | | $151.36 | $190.55 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $263.03 / $363.08
| Professional | | $213.80 | $263.03 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $60.26 / $331.13
| Professional | | $32.36 | $60.26 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $389.05 / $407.38
| Professional | | $275.42 | $389.05 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $275.42 / $457.09
| Professional | | $186.21 | $275.42 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $213.80 / $331.13
| Professional | | $51.29 | $213.80 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $218.78 / $331.13
| Professional | | $169.82 | $218.78 | $331.13 |