- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.65 / $151.83 / $212.40
| Professional | | $136.65 | $151.83 | $212.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.86 / $206.40 / $243.47
| Professional | | $168.86 | $206.40 | $243.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.40 / $69.22 / $211.74
| Professional | | $45.40 | $69.22 | $211.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.36 / $304.08 / $1,052.14
| Professional | | $220.36 | $304.08 | $1,052.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $155.09
| Professional | | $32.34 | $32.34 | $155.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.53 / $220.36 / $302.32
| Professional | | $181.53 | $220.36 | $302.32 |