- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.40 / $153.72 / $734.30
| Professional | | $100.40 | $153.72 | $734.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.38 / $288.33 / $807.24
| Professional | | $108.38 | $288.33 | $807.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.82 / $212.27 / $1,030.16
| Professional | | $112.82 | $212.27 | $1,030.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.17 / $326.12 / $1,060.10
| Professional | | $107.17 | $326.12 | $1,060.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.40 / $189.39 / $734.30
| Professional | | $91.40 | $189.39 | $734.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.98 / $659.44 / $1,229.28
| Professional | | $492.98 | $659.44 | $1,229.28 |