- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.30 / $148.55 / $243.46
| Professional | | $114.30 | $148.55 | $243.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.24 / $238.24 / $293.41
| Professional | | $238.24 | $238.24 | $293.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.44 / $190.04 / $270.19
| Professional | | $124.44 | $190.04 | $270.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.94 / $222.42 / $507.61
| Professional | | $150.94 | $222.42 | $507.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.41 / $145.74 / $196.22
| Professional | | $137.41 | $145.74 | $196.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $226.41
| Professional | | $32.34 | $32.34 | $226.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.88 / $210.33 / $365.03
| Professional | | $146.88 | $210.33 | $365.03 |