- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $141.25 / $223.87
| Professional | | $114.82 | $141.25 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $107.15 / $154.88
| Professional | | $91.20 | $107.15 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $234.42 / $346.74
| Professional | | $123.03 | $234.42 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $134.90 / $162.18
| Professional | | $104.71 | $134.90 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $165.96 / $288.40
| Professional | | $114.82 | $165.96 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $144.54 / $208.93
| Professional | | $114.82 | $144.54 | $208.93 |