- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.54 / $132.91 / $184.21
| Professional | | $122.54 | $132.91 | $184.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.87 / $171.61 / $171.61
| Professional | | $145.87 | $171.61 | $171.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.65 / $138.61 / $202.22
| Professional | | $102.65 | $138.61 | $202.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.42 / $143.77 / $888.45
| Professional | | $106.42 | $143.77 | $888.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.82 / $129.01 / $185.85
| Professional | | $101.82 | $129.01 | $185.85 |