- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.71 / $122.19 / $154.51
| Professional | | $97.71 | $122.19 | $154.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.38 / $204.86 / $787.82
| Professional | | $136.38 | $204.86 | $787.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.51 / $109.51 / $154.77
| Professional | | $109.51 | $109.51 | $154.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.55 / $176.33 / $284.74
| Professional | | $139.55 | $176.33 | $284.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.22 / $211.93 / $328.11
| Professional | | $123.22 | $211.93 | $328.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.38 / $208.81 / $787.82
| Professional | | $136.38 | $208.81 | $787.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.38 / $180.01 / $369.41
| Professional | | $136.38 | $180.01 | $369.41 |