- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.77 / $229.37 / $277.14
| Professional | | $139.77 | $229.37 | $277.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.01 / $203.18 / $342.86
| Professional | | $122.01 | $203.18 | $342.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.22 / $257.85 / $395.73
| Professional | | $150.22 | $257.85 | $395.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.85 / $171.19 / $281.43
| Professional | | $152.85 | $171.19 | $281.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.45 / $81.02 / $184.65
| Professional | | $56.45 | $81.02 | $184.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.65 / $216.08 / $308.81
| Professional | | $188.65 | $216.08 | $308.81 |