- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.61 / $236.34 / $416.36
| Professional | | $142.61 | $236.34 | $416.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.74 / $269.55 / $451.97
| Professional | | $168.74 | $269.55 | $451.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.07 / $271.86 / $460.40
| Professional | | $155.07 | $271.86 | $460.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.72 / $371.01 / $941.71
| Professional | | $195.72 | $371.01 | $941.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.56 / $183.38 / $354.64
| Professional | | $171.56 | $183.38 | $354.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $401.02
| Professional | | $32.34 | $32.34 | $401.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.50 / $305.32 / $535.16
| Professional | | $220.50 | $305.32 | $535.16 |