- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.96 / $126.70 / $645.05
| Professional | | $123.96 | $126.70 | $645.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.65 / $112.86 / $141.08
| Professional | | $84.65 | $112.86 | $141.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.05 / $150.06 / $266.30
| Professional | | $114.05 | $150.06 | $266.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.65 / $145.08 / $1,156.83
| Professional | | $111.65 | $145.08 | $1,156.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.98 / $133.37 / $236.99
| Professional | | $110.98 | $133.37 | $236.99 |