- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.74 / $202.82 / $467.56
| Professional | | $120.74 | $202.82 | $467.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.31 / $143.53 / $209.15
| Professional | | $123.31 | $143.53 | $209.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.41 / $199.51 / $386.54
| Professional | | $107.41 | $199.51 | $386.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.50 / $191.52 / $412.22
| Professional | | $98.50 | $191.52 | $412.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.44 / $118.90 / $254.75
| Professional | | $109.44 | $118.90 | $254.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.32 / $280.02 / $452.34
| Professional | | $214.32 | $280.02 | $452.34 |