- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.32 / $117.43 / $363.12
| Professional | | $101.32 | $117.43 | $363.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.41 / $273.86 / $437.50
| Professional | | $91.41 | $273.86 | $437.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.46 / $354.37 / $752.06
| Professional | | $148.46 | $354.37 | $752.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.76 / $507.76 / $507.76
| Professional | | $507.76 | $507.76 | $507.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.82 / $449.52 / $687.82
| Professional | | $273.82 | $449.52 | $687.82 |