- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.77 / $903.87 / $1,147.29
| Professional | | $161.77 | $903.87 | $1,147.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.02 / $137.36 / $149.38
| Professional | | $103.02 | $137.36 | $149.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.95 / $124.73 / $458.16
| Professional | | $0.95 | $124.73 | $458.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.77 / $219.10 / $1,308.32
| Professional | | $144.77 | $219.10 | $1,308.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.30 / $195.03 / $345.51
| Professional | | $144.30 | $195.03 | $345.51 |