- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.02 / $136.69 / $237.02
| Professional | | $103.02 | $136.69 | $237.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.73 / $301.80 / $442.26
| Professional | | $178.73 | $301.80 | $442.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.65 / $169.40 / $178.12
| Professional | | $141.65 | $169.40 | $178.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.25 / $140.25 / $162.69
| Professional | | $140.25 | $140.25 | $162.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.45 / $274.64 / $518.69
| Professional | | $165.45 | $274.64 | $518.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.56 / $265.31 / $478.22
| Professional | | $156.56 | $265.31 | $478.22 |