- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.88 / $125.18 / $200.03
| Professional | | $119.88 | $125.18 | $200.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.33 / $203.43 / $358.44
| Professional | | $137.33 | $203.43 | $358.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.44 / $152.60 / $298.06
| Professional | | $112.44 | $152.60 | $298.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.85 / $95.68 / $208.81
| Professional | | $56.85 | $95.68 | $208.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.21 / $186.56 / $351.40
| Professional | | $151.21 | $186.56 | $351.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.31 / $127.31 / $127.31
| Professional | | $127.31 | $127.31 | $127.31 |