- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.25 / $117.65 / $216.26
| Professional | | $84.25 | $117.65 | $216.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.48 / $188.51 / $296.83
| Professional | | $106.48 | $188.51 | $296.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.67 / $148.54 / $261.22
| Professional | | $100.67 | $148.54 | $261.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.57 / $152.00 / $164.00
| Professional | | $141.57 | $152.00 | $164.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.17 / $160.71 / $223.10
| Professional | | $124.17 | $160.71 | $223.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.31 / $141.91 / $290.45
| Professional | | $100.31 | $141.91 | $290.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.48 / $918.72 / $1,090.28
| Professional | | $632.48 | $918.72 | $1,090.28 |