- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.85 / $243.24 / $805.60
| Professional | | $132.85 | $243.24 | $805.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.27 / $260.32 / $325.39
| Professional | | $211.27 | $260.32 | $325.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.66 / $241.50 / $907.92
| Professional | | $151.66 | $241.50 | $907.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.10 / $262.31 / $337.68
| Professional | | $198.10 | $262.31 | $337.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.04 / $209.37 / $238.71
| Professional | | $163.04 | $209.37 | $238.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.30 / $236.04 / $275.74
| Professional | | $141.30 | $236.04 | $275.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.60 / $284.60 / $284.60
| Professional | | $232.60 | $284.60 | $284.60 |