- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.34 / $182.59 / $221.07
| Professional | | $124.34 | $182.59 | $221.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.45 / $117.31 / $237.14
| Professional | | $102.45 | $117.31 | $237.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.00 / $186.00 / $186.00
| Professional | | $186.00 | $186.00 | $186.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.38 / $176.94 / $242.00
| Professional | | $124.38 | $176.94 | $242.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.53 / $142.55 / $235.10
| Professional | | $110.53 | $142.55 | $235.10 |