- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $123.03 / $275.42
| Professional | | $97.72 | $123.03 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $208.93 / $213.80
| Professional | | $177.83 | $208.93 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $158.49 / $208.93
| Professional | | $107.15 | $158.49 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $158.49 / $218.78
| Professional | | $97.72 | $158.49 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $204.17 / $223.87
| Professional | | $144.54 | $204.17 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $97.72 / $1,122.02
| Professional | | $83.18 | $97.72 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $144.54 / $204.17
| Professional | | $104.71 | $144.54 | $204.17 |