- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.82 / $164.84 / $391.28
| Professional | | $140.82 | $164.84 | $391.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.04 / $272.05 / $531.83
| Professional | | $170.04 | $272.05 | $531.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.17 / $339.47 / $563.85
| Professional | | $194.17 | $339.47 | $563.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.49 / $289.33 / $763.29
| Professional | | $181.49 | $289.33 | $763.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.03 / $158.75 / $305.23
| Professional | | $106.03 | $158.75 | $305.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.30 / $262.04 / $481.28
| Professional | | $185.30 | $262.04 | $481.28 |