- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.04 / $238.52 / $355.23
| Professional | | $118.04 | $238.52 | $355.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.91 / $182.76 / $318.37
| Professional | | $91.91 | $182.76 | $318.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.73 / $245.76 / $555.94
| Professional | | $107.73 | $245.76 | $555.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.29 / $283.60 / $587.29
| Professional | | $117.29 | $283.60 | $587.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.42 / $358.02 / $860.21
| Professional | | $231.42 | $358.02 | $860.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.60 / $194.14 / $282.92
| Professional | | $102.60 | $194.14 | $282.92 |