- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $234.42 / $512.86
| Professional | | $144.54 | $234.42 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $275.42 / $467.74
| Professional | | $177.83 | $275.42 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $380.19
| Professional | | $32.36 | $33.11 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $346.74 / $501.19
| Professional | | $208.93 | $346.74 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $281.84 / $645.65
| Professional | | $154.88 | $281.84 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $288.40 / $489.78
| Professional | | $190.55 | $288.40 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $251.19 / $467.74
| Professional | | $158.49 | $251.19 | $467.74 |