- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.10 / $167.83 / $284.47
| Professional | | $98.10 | $167.83 | $284.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.35 / $179.55 / $242.23
| Professional | | $129.35 | $179.55 | $242.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.32 / $233.77 / $283.36
| Professional | | $171.32 | $233.77 | $283.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $152.00 / $226.01
| Professional | | $32.34 | $152.00 | $226.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.29 / $245.30 / $295.11
| Professional | | $181.29 | $245.30 | $295.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.13 / $211.14 / $298.22
| Professional | | $153.13 | $211.14 | $298.22 |