- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.77 / $124.46 / $153.69
| Professional | | $112.77 | $124.46 | $153.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.04 / $274.04 / $322.39
| Professional | | $274.04 | $274.04 | $322.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.07 / $212.82 / $212.82
| Professional | | $198.07 | $212.82 | $212.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.07 / $161.27 / $244.64
| Professional | | $126.07 | $161.27 | $244.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.08 / $158.61 / $198.14
| Professional | | $124.08 | $158.61 | $198.14 |