- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.32 / $134.47 / $425.36
| Professional | | $117.32 | $134.47 | $425.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.72 / $187.68 / $312.24
| Professional | | $127.72 | $187.68 | $312.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.37 / $275.89 / $486.43
| Professional | | $187.37 | $275.89 | $486.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.44 / $290.07 / $566.90
| Professional | | $143.44 | $290.07 | $566.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.31 / $247.41 / $458.32
| Professional | | $194.31 | $247.41 | $458.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.34 / $125.08 / $167.27
| Professional | | $89.34 | $125.08 | $167.27 |