- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.17 / $132.30 / $362.51
| Professional | | $106.17 | $132.30 | $362.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.59 / $165.77 / $217.82
| Professional | | $148.59 | $165.77 | $217.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.99 / $165.77 / $401.31
| Professional | | $118.99 | $165.77 | $401.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.05 / $203.96 / $267.33
| Professional | | $139.05 | $203.96 | $267.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.18 / $138.69 / $226.31
| Professional | | $96.18 | $138.69 | $226.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.49 / $181.83 / $225.39
| Professional | | $126.49 | $181.83 | $225.39 |