- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.22 / $152.90 / $176.88
| Professional | | $124.22 | $152.90 | $176.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.82 / $252.64 / $315.80
| Professional | | $218.82 | $252.64 | $315.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.63 / $243.09 / $880.77
| Professional | | $117.63 | $243.09 | $880.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.44 / $253.51 / $294.69
| Professional | | $173.44 | $253.51 | $294.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.26 / $197.74 / $232.88
| Professional | | $138.26 | $197.74 | $232.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.38 / $241.06 / $283.61
| Professional | | $129.38 | $241.06 | $283.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.20 / $293.89 / $293.89
| Professional | | $240.20 | $293.89 | $293.89 |