- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.14 / $140.08 / $190.78
| Professional | | $119.14 | $140.08 | $190.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.58 / $315.97 / $438.37
| Professional | | $141.58 | $315.97 | $438.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.83 / $93.64 / $144.44
| Professional | | $35.83 | $93.64 | $144.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.31 / $304.64 / $528.16
| Professional | | $138.31 | $304.64 | $528.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.09 / $183.96 / $352.03
| Professional | | $122.09 | $183.96 | $352.03 |