- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.60 / $127.37 / $130.68
| Professional | | $116.60 | $127.37 | $130.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.81 / $220.20 / $401.79
| Professional | | $186.81 | $220.20 | $401.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.91 / $164.18 / $259.89
| Professional | | $126.91 | $164.18 | $259.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.68 / $166.61 / $259.89
| Professional | | $121.68 | $166.61 | $259.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.61 / $169.47 / $474.55
| Professional | | $154.61 | $169.47 | $474.55 |