- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.74 / $225.56 / $228.61
| Professional | | $103.74 | $225.56 | $228.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.85 / $243.85 / $277.99
| Professional | | $243.85 | $243.85 | $277.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.55 / $216.76 / $880.58
| Professional | | $161.55 | $216.76 | $880.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.81 / $365.77 / $457.22
| Professional | | $304.81 | $365.77 | $457.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.02 / $137.16 / $243.71
| Professional | | $128.02 | $137.16 | $243.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.41 / $152.41 / $152.41
| Professional | | $152.41 | $152.41 | $152.41 |