- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.08 / $142.88 / $678.67
| Professional | | $136.08 | $142.88 | $678.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.17 / $156.77 / $221.40
| Professional | | $127.17 | $156.77 | $221.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.34 / $149.46 / $223.45
| Professional | | $112.34 | $149.46 | $223.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.62 / $146.62 / $291.62
| Professional | | $0.62 | $146.62 | $291.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.42 / $125.98 / $336.48
| Professional | | $0.42 | $125.98 | $336.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.90 / $155.85 / $232.25
| Professional | | $126.90 | $155.85 | $232.25 |