- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.11 / $147.72 / $253.68
| Professional | | $117.11 | $147.72 | $253.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.81 / $226.06 / $244.98
| Professional | | $156.81 | $226.06 | $244.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.53 / $194.07 / $291.47
| Professional | | $140.53 | $194.07 | $291.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.47 / $221.79 / $691.79
| Professional | | $152.47 | $221.79 | $691.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.71 / $164.59 / $180.21
| Professional | | $154.71 | $164.59 | $180.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $207.93
| Professional | | $32.34 | $32.34 | $207.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.80 / $186.10 / $303.72
| Professional | | $137.80 | $186.10 | $303.72 |