- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.71 / $134.85 / $265.64
| Professional | | $106.71 | $134.85 | $265.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.96 / $205.72 / $253.49
| Professional | | $116.96 | $205.72 | $253.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.51 / $109.51 / $109.51
| Professional | | $109.51 | $109.51 | $109.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.40 / $193.03 / $207.11
| Professional | | $152.40 | $193.03 | $207.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.66 / $143.43 / $265.64
| Professional | | $110.66 | $143.43 | $265.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.70 / $185.56 / $250.76
| Professional | | $85.70 | $185.56 | $250.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.51 / $109.51 / $109.51
| Professional | | $109.51 | $109.51 | $109.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.65 / $122.35 / $142.88
| Professional | | $119.65 | $122.35 | $142.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.82 / $152.74 / $265.31
| Professional | | $104.82 | $152.74 | $265.31 |