- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.75 / $125.81 / $173.08
| Professional | | $95.75 | $125.81 | $173.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.11 / $166.11 / $537.80
| Professional | | $166.11 | $166.11 | $537.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.59 / $184.03 / $326.70
| Professional | | $124.59 | $184.03 | $326.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.88 / $191.65 / $281.48
| Professional | | $136.88 | $191.65 | $281.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.35 / $208.49 / $596.53
| Professional | | $194.35 | $208.49 | $596.53 |