- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.32 / $170.43 / $283.17
| Professional | | $111.32 | $170.43 | $283.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.81 / $158.27 / $250.56
| Professional | | $91.81 | $158.27 | $250.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.55 / $155.06 / $291.41
| Professional | | $117.55 | $155.06 | $291.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.86 / $211.28 / $397.91
| Professional | | $119.86 | $211.28 | $397.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $218.75
| Professional | | $32.34 | $32.34 | $218.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.72 / $257.25 / $412.71
| Professional | | $185.72 | $257.25 | $412.71 |