- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.17 / $138.90 / $256.77
| Professional | | $106.17 | $138.90 | $256.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.40 / $191.53 / $219.56
| Professional | | $148.40 | $191.53 | $219.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.17 / $254.73 / $313.61
| Professional | | $240.17 | $254.73 | $313.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $253.21
| Professional | | $32.34 | $32.34 | $253.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.70 / $297.29 / $313.61
| Professional | | $252.70 | $297.29 | $313.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.37 / $153.96 / $248.99
| Professional | | $133.37 | $153.96 | $248.99 |