- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.02 / $183.13 / $225.58
| Professional | | $119.02 | $183.13 | $225.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.61 / $116.90 / $187.98
| Professional | | $97.61 | $116.90 | $187.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.38 / $207.57 / $402.44
| Professional | | $154.38 | $207.57 | $402.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.77 / $227.24 / $433.77
| Professional | | $138.77 | $227.24 | $433.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.11 / $290.35 / $447.40
| Professional | | $189.11 | $290.35 | $447.40 |