- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.52 / $119.52 / $770.21
| Professional | | $119.52 | $119.52 | $770.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.65 / $231.58 / $237.37
| Professional | | $216.65 | $231.58 | $237.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.00 / $214.75 / $338.27
| Professional | | $141.00 | $214.75 | $338.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.85 / $253.38 / $847.87
| Professional | | $142.85 | $253.38 | $847.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.13 / $220.12 / $347.08
| Professional | | $166.13 | $220.12 | $347.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.48 / $127.48 / $222.28
| Professional | | $127.48 | $127.48 | $222.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.41 / $253.38 / $325.85
| Professional | | $156.41 | $253.38 | $325.85 |