- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.27 / $147.38 / $391.91
| Professional | | $108.27 | $147.38 | $391.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.62 / $213.06 / $370.16
| Professional | | $125.62 | $213.06 | $370.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.14 / $298.16 / $585.19
| Professional | | $202.14 | $298.16 | $585.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.00 / $335.62 / $667.44
| Professional | | $154.00 | $335.62 | $667.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.03 / $294.20 / $798.37
| Professional | | $207.03 | $294.20 | $798.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.05 / $127.47 / $194.42
| Professional | | $91.05 | $127.47 | $194.42 |