- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.91 / $110.50 / $348.60
| Professional | | $78.91 | $110.50 | $348.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.87 / $346.38 / $1,178.33
| Professional | | $183.87 | $346.38 | $1,178.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.92 / $234.09 / $282.51
| Professional | | $185.92 | $234.09 | $282.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.68 / $178.00 / $548.08
| Professional | | $135.68 | $178.00 | $548.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.72 / $92.35 / $228.91
| Professional | | $70.72 | $92.35 | $228.91 |