- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.72 / $136.57 / $212.84
| Professional | | $114.72 | $136.57 | $212.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.47 / $101.47 / $105.13
| Professional | | $101.47 | $101.47 | $105.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.49 / $163.41 / $239.89
| Professional | | $113.49 | $163.41 | $239.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.77 / $175.33 / $305.13
| Professional | | $123.77 | $175.33 | $305.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.69 / $170.27 / $886.02
| Professional | | $126.69 | $170.27 | $886.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.64 / $153.07 / $234.92
| Professional | | $117.64 | $153.07 | $234.92 |