- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.34 / $153.49 / $652.33
| Professional | | $101.34 | $153.49 | $652.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.26 / $178.43 / $257.94
| Professional | | $128.26 | $178.43 | $257.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.79 / $117.29 / $161.73
| Professional | | $78.79 | $117.29 | $161.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.59 / $228.70 / $351.20
| Professional | | $147.59 | $228.70 | $351.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.83 / $166.13 / $282.72
| Professional | | $133.83 | $166.13 | $282.72 |