- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.47 / $173.49 / $247.06
| Professional | | $160.47 | $173.49 | $247.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.44 / $211.09 / $235.67
| Professional | | $172.44 | $211.09 | $235.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.27 / $206.05 / $235.48
| Professional | | $194.27 | $206.05 | $235.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.37 / $32.34 / $216.00
| Professional | | $22.37 | $32.34 | $216.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.67 / $185.67 / $231.48
| Professional | | $185.67 | $185.67 | $231.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.67 / $173.00 / $256.83
| Professional | | $126.67 | $173.00 | $256.83 |