- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.19 / $144.79 / $678.67
| Professional | | $129.19 | $144.79 | $678.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.80 / $107.73 / $134.66
| Professional | | $80.80 | $107.73 | $134.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.68 / $159.36 / $284.32
| Professional | | $123.68 | $159.36 | $284.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.44 / $151.34 / $2,654.97
| Professional | | $118.44 | $151.34 | $2,654.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.32 / $141.36 / $255.38
| Professional | | $115.32 | $141.36 | $255.38 |