- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.12 / $185.69 / $241.07
| Professional | | $167.12 | $185.69 | $241.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.86 / $213.10 / $401.48
| Professional | | $175.86 | $213.10 | $401.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.98 / $107.11 / $215.19
| Professional | | $79.98 | $107.11 | $215.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.26 / $301.74 / $501.55
| Professional | | $225.26 | $301.74 | $501.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $169.08
| Professional | | $32.34 | $32.34 | $169.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $231.35 / $271.83
| Professional | | $181.97 | $231.35 | $271.83 |