- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.87 / $165.32 / $251.01
| Professional | | $106.87 | $165.32 | $251.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.65 / $253.41 / $327.12
| Professional | | $127.65 | $253.41 | $327.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.33 / $171.40 / $371.50
| Professional | | $126.33 | $171.40 | $371.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.42 / $244.35 / $244.35
| Professional | | $182.42 | $244.35 | $244.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.22 / $232.25 / $442.36
| Professional | | $138.22 | $232.25 | $442.36 |