- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.05 / $104.04 / $327.52
| Professional | | $64.05 | $104.04 | $327.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.51 / $161.09 / $214.78
| Professional | | $94.51 | $161.09 | $214.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.31 / $241.52 / $328.33
| Professional | | $152.31 | $241.52 | $328.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.44 / $204.08 / $888.45
| Professional | | $128.44 | $204.08 | $888.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.91 / $233.62 / $324.33
| Professional | | $148.91 | $233.62 | $324.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.60 / $136.60 / $262.70
| Professional | | $136.60 | $136.60 | $262.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.32 / $167.09 / $258.67
| Professional | | $125.32 | $167.09 | $258.67 |