- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.26 / $120.69 / $583.01
| Professional | | $97.26 | $120.69 | $583.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.45 / $286.89 / $440.80
| Professional | | $278.45 | $286.89 | $440.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.54 / $183.27 / $213.55
| Professional | | $106.54 | $183.27 | $213.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.25 / $177.30 / $213.55
| Professional | | $102.25 | $177.30 | $213.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.91 / $150.19 / $497.59
| Professional | | $120.91 | $150.19 | $497.59 |