- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.94 / $134.09 / $242.26
| Professional | | $46.94 | $134.09 | $242.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.72 / $215.46 / $290.25
| Professional | | $127.72 | $215.46 | $290.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.69 / $280.56 / $353.20
| Professional | | $149.69 | $280.56 | $353.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.74 / $276.97 / $1,004.88
| Professional | | $160.74 | $276.97 | $1,004.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.00 / $278.60 / $364.58
| Professional | | $192.00 | $278.60 | $364.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.72 / $159.04 / $234.04
| Professional | | $35.72 | $159.04 | $234.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.74 / $289.16 / $350.26
| Professional | | $160.74 | $289.16 | $350.26 |