- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $81.28 / $398.11
| Professional | | $32.36 | $81.28 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $114.82 / $229.09
| Professional | | $38.02 | $114.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $245.47 / $602.56
| Professional | | $151.36 | $245.47 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $162.18 / $223.87
| Professional | | $22.39 | $162.18 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $181.97 / $281.84
| Professional | | $141.25 | $181.97 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $40.74 / $102.33
| Professional | | $29.51 | $40.74 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $234.42
| Professional | | $138.04 | $138.04 | $234.42 |