- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.27 / $156.12 / $246.23
| Professional | | $112.27 | $156.12 | $246.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.47 / $148.79 / $206.33
| Professional | | $126.47 | $148.79 | $206.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.76 / $180.36 / $305.42
| Professional | | $122.76 | $180.36 | $305.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.01 / $205.67 / $1,166.24
| Professional | | $154.01 | $205.67 | $1,166.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.36 / $181.94 / $251.94
| Professional | | $148.36 | $181.94 | $251.94 |