- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.65 / $197.51 / $296.52
| Professional | | $114.65 | $197.51 | $296.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.82 / $115.88 / $198.30
| Professional | | $31.82 | $115.88 | $198.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.78 / $213.47 / $442.25
| Professional | | $122.78 | $213.47 | $442.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.44 / $221.34 / $356.51
| Professional | | $150.44 | $221.34 | $356.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.56 / $161.25 / $247.53
| Professional | | $30.56 | $161.25 | $247.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.69 / $284.18 / $371.67
| Professional | | $219.69 | $284.18 | $371.67 |