- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.17 / $120.28 / $186.78
| Professional | | $106.17 | $120.28 | $186.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.47 / $154.47 / $154.47
| Professional | | $154.47 | $154.47 | $154.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.40 / $140.76 / $235.55
| Professional | | $102.40 | $140.76 | $235.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.70 / $181.12 / $291.26
| Professional | | $113.70 | $181.12 | $291.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $832.84 / $832.84 / $1,291.95
| Professional | | $832.84 | $832.84 | $1,291.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.09 / $134.51 / $319.45
| Professional | | $112.09 | $134.51 | $319.45 |