- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.77 / $122.16 / $179.25
| Professional | | $83.77 | $122.16 | $179.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.91 / $174.74 / $532.11
| Professional | | $143.91 | $174.74 | $532.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.23 / $137.55 / $371.38
| Professional | | $90.23 | $137.55 | $371.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.65 / $185.31 / $371.38
| Professional | | $112.65 | $185.31 | $371.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.41 / $159.86 / $524.90
| Professional | | $135.41 | $159.86 | $524.90 |