- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.71 / $136.54 / $263.08
| Professional | | $61.71 | $136.54 | $263.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.20 / $257.81 / $929.00
| Professional | | $102.20 | $257.81 | $929.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.42 / $178.89 / $420.09
| Professional | | $78.42 | $178.89 | $420.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.25 / $166.41 / $361.88
| Professional | | $91.25 | $166.41 | $361.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.71 / $217.29 / $364.69
| Professional | | $36.71 | $217.29 | $364.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.97 / $204.74 / $380.09
| Professional | | $107.97 | $204.74 | $380.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.01 / $199.58 / $340.26
| Professional | | $105.01 | $199.58 | $340.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.76 / $253.20 / $423.84
| Professional | | $159.76 | $253.20 | $423.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.97 / $68.97 / $169.99
| Professional | | $68.97 | $68.97 | $169.99 |