- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $208.93 / $316.23
| Professional | | $102.33 | $208.93 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $245.47 / $446.68
| Professional | | $134.90 | $245.47 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $234.42 / $371.54
| Professional | | $125.89 | $234.42 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $263.03 / $616.60
| Professional | | $109.65 | $263.03 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $186.21 / $245.47
| Professional | | $77.62 | $186.21 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $251.19 / $436.52
| Professional | | $128.82 | $251.19 | $436.52 |