- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $144.54 / $190.55
| Professional | | $123.03 | $144.54 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $138.04 / $204.17
| Professional | | $117.49 | $138.04 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $169.82 / $199.53
| Professional | | $109.65 | $169.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $218.78 / $812.83
| Professional | | $134.90 | $218.78 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $173.78 / $245.47
| Professional | | $112.20 | $173.78 | $245.47 |