- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $141.25 / $234.42
| Professional | | $114.82 | $141.25 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $190.55 / $199.53
| Professional | | $128.82 | $190.55 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $239.88 / $524.81
| Professional | | $151.36 | $239.88 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $173.78 / $234.42
| Professional | | $123.03 | $173.78 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $239.88 / $512.86
| Professional | | $144.54 | $239.88 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $186.21 / $338.84
| Professional | | $138.04 | $186.21 | $338.84 |