- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $169.82 / $575.44
| Professional | | $128.82 | $169.82 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $107.15 / $120.23
| Professional | | $102.33 | $107.15 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $194.98 / $208.93
| Professional | | $186.21 | $194.98 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $173.78 / $562.34
| Professional | | $117.49 | $173.78 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $154.88 / $275.42
| Professional | | $128.82 | $154.88 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $154.88 / $549.54
| Professional | | $114.82 | $154.88 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $141.25 / $186.21
| Professional | | $109.65 | $141.25 | $186.21 |