- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.21 / $143.72 / $322.81
| Professional | | $102.21 | $143.72 | $322.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.77 / $135.35 / $231.67
| Professional | | $75.77 | $135.35 | $231.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.21 / $176.06 / $269.49
| Professional | | $122.21 | $176.06 | $269.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $222.36
| Professional | | $32.34 | $32.34 | $222.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.18 / $197.49 / $300.83
| Professional | | $126.18 | $197.49 | $300.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.38 / $220.01 / $329.39
| Professional | | $157.38 | $220.01 | $329.39 |