- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.64 / $206.12 / $225.36
| Professional | | $178.64 | $206.12 | $225.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.83 / $302.31 / $344.63
| Professional | | $274.83 | $302.31 | $344.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.38 / $169.92 / $675.23
| Professional | | $142.38 | $169.92 | $675.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.83 / $329.80 / $412.25
| Professional | | $274.83 | $329.80 | $412.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.43 / $131.19 / $219.74
| Professional | | $115.43 | $131.19 | $219.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.41 / $137.41 / $137.41
| Professional | | $137.41 | $137.41 | $137.41 |