- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.08 / $158.83 / $313.22
| Professional | | $152.08 | $158.83 | $313.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.25 / $235.42 / $445.92
| Professional | | $108.25 | $235.42 | $445.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.24 / $145.40 / $164.01
| Professional | | $128.24 | $145.40 | $164.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.42 / $500.68 / $1,149.43
| Professional | | $238.42 | $500.68 | $1,149.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.04 / $171.95 / $472.58
| Professional | | $119.04 | $171.95 | $472.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.32 / $198.41 / $270.93
| Professional | | $125.32 | $198.41 | $270.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.43 / $228.42 / $407.25
| Professional | | $156.43 | $228.42 | $407.25 |