- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.63 / $174.60 / $257.74
| Professional | | $114.63 | $174.60 | $257.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.06 / $229.87 / $403.23
| Professional | | $138.06 | $229.87 | $403.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.51 / $158.97 / $284.20
| Professional | | $129.51 | $158.97 | $284.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.62 / $195.89 / $301.60
| Professional | | $33.62 | $195.89 | $301.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.54 / $262.47 / $457.05
| Professional | | $179.54 | $262.47 | $457.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.07 / $175.41 / $175.41
| Professional | | $111.07 | $175.41 | $175.41 |