- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.23 / $128.06 / $188.14
| Professional | | $115.23 | $128.06 | $188.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.01 / $146.35 / $205.58
| Professional | | $115.01 | $146.35 | $205.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.51 / $109.51 / $109.51
| Professional | | $109.51 | $109.51 | $109.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.93 / $168.84 / $173.25
| Professional | | $120.93 | $168.84 | $173.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.39 / $226.52 / $297.74
| Professional | | $180.39 | $226.52 | $297.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.96 / $172.22 / $541.64
| Professional | | $122.96 | $172.22 | $541.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.04 / $166.37 / $257.72
| Professional | | $86.04 | $166.37 | $257.72 |