- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.96 / $118.77 / $173.49
| Professional | | $108.96 | $118.77 | $173.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.31 / $176.83 / $176.83
| Professional | | $150.31 | $176.83 | $176.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.80 / $153.54 / $280.83
| Professional | | $50.80 | $153.54 | $280.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.32 / $165.38 / $1,004.88
| Professional | | $127.32 | $165.38 | $1,004.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.02 / $160.96 / $203.44
| Professional | | $122.02 | $160.96 | $203.44 |