- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.56 / $205.39 / $792.82
| Professional | | $137.56 | $205.39 | $792.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.81 / $217.29 / $340.29
| Professional | | $154.81 | $217.29 | $340.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.98 / $120.45 / $190.84
| Professional | | $25.98 | $120.45 | $190.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.04 / $276.45 / $392.20
| Professional | | $201.04 | $276.45 | $392.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.47 / $183.60 / $295.80
| Professional | | $151.47 | $183.60 | $295.80 |