- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $218.78 / $660.69
| Professional | | $109.65 | $218.78 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $177.83 / $331.13
| Professional | | $102.33 | $177.83 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $257.04 / $426.58
| Professional | | $138.04 | $257.04 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $208.93 / $338.84
| Professional | | $93.33 | $208.93 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $251.19 / $660.69
| Professional | | $114.82 | $251.19 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $218.78 / $398.11
| Professional | | $107.15 | $218.78 | $398.11 |