- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.10 / $127.46 / $154.31
| Professional | | $97.10 | $127.46 | $154.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.78 / $110.02 / $149.91
| Professional | | $104.78 | $110.02 | $149.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.26 / $152.19 / $282.38
| Professional | | $115.26 | $152.19 | $282.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.51 / $588.51 / $588.51
| Professional | | $588.51 | $588.51 | $588.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.03 / $148.02 / $230.35
| Professional | | $115.03 | $148.02 | $230.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.83 / $126.68 / $192.83
| Professional | | $98.83 | $126.68 | $192.83 |