- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $154.88 / $380.19
| Professional | | $102.33 | $154.88 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $1,380.38 / $2,454.71
| Professional | | $154.88 | $1,380.38 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $173.78 / $331.13
| Professional | | $128.82 | $173.78 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $125.89 / $295.12
| Professional | | $117.49 | $125.89 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $169.82 / $338.84
| Professional | | $114.82 | $169.82 | $338.84 |