- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.76 / $153.54 / $240.35
| Professional | | $101.76 | $153.54 | $240.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.75 / $219.08 / $310.52
| Professional | | $137.75 | $219.08 | $310.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.80 / $198.72 / $289.50
| Professional | | $138.80 | $198.72 | $289.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.36 / $245.75 / $532.40
| Professional | | $154.36 | $245.75 | $532.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.37 / $143.34 / $224.64
| Professional | | $132.37 | $143.34 | $224.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $259.20
| Professional | | $32.34 | $32.34 | $259.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.09 / $212.01 / $398.40
| Professional | | $140.09 | $212.01 | $398.40 |