- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.84 / $153.85 / $213.13
| Professional | | $128.84 | $153.85 | $213.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.91 / $206.93 / $326.92
| Professional | | $132.91 | $206.93 | $326.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.18 / $144.36 / $198.18
| Professional | | $72.18 | $144.36 | $198.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.92 / $145.02 / $256.84
| Professional | | $31.92 | $145.02 | $256.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.31 / $176.25 / $311.27
| Professional | | $126.31 | $176.25 | $311.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.00 / $144.00 / $144.00
| Professional | | $120.00 | $144.00 | $144.00 |