- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.11 / $235.86 / $420.22
| Professional | | $171.11 | $235.86 | $420.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.21 / $226.25 / $385.53
| Professional | | $153.21 | $226.25 | $385.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.79 / $198.79 / $467.28
| Professional | | $198.79 | $198.79 | $467.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $320.08
| Professional | | $32.34 | $32.34 | $320.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.79 / $198.79 / $198.79
| Professional | | $198.79 | $198.79 | $198.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.43 / $328.86 / $513.03
| Professional | | $244.43 | $328.86 | $513.03 |