- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.82 / $167.28 / $731.32
| Professional | | $123.82 | $167.28 | $731.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.45 / $118.56 / $151.28
| Professional | | $81.45 | $118.56 | $151.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.85 / $102.85 / $135.18
| Professional | | $102.85 | $102.85 | $135.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.59 / $173.33 / $301.38
| Professional | | $125.59 | $173.33 | $301.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.17 / $175.66 / $907.92
| Professional | | $126.17 | $175.66 | $907.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.92 / $151.33 / $278.12
| Professional | | $121.92 | $151.33 | $278.12 |