- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.20 / $150.75 / $216.89
| Professional | | $124.20 | $150.75 | $216.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.82 / $120.92 / $195.63
| Professional | | $83.82 | $120.92 | $195.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.16 / $183.70 / $241.56
| Professional | | $127.16 | $183.70 | $241.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $170.86
| Professional | | $32.34 | $32.34 | $170.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.44 / $202.70 / $369.28
| Professional | | $136.44 | $202.70 | $369.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.35 / $202.37 / $293.23
| Professional | | $151.35 | $202.37 | $293.23 |