- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.82 / $140.08 / $761.44
| Professional | | $118.82 | $140.08 | $761.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.26 / $128.34 / $139.57
| Professional | | $96.26 | $128.34 | $139.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.84 / $224.22 / $366.59
| Professional | | $125.84 | $224.22 | $366.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.08 / $212.76 / $1,760.08
| Professional | | $129.08 | $212.76 | $1,760.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.38 / $175.18 / $316.67
| Professional | | $123.38 | $175.18 | $316.67 |