- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.46 / $132.71 / $222.92
| Professional | | $127.46 | $132.71 | $222.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.36 / $174.36 / $254.11
| Professional | | $174.36 | $174.36 | $254.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.86 / $238.30 / $592.03
| Professional | | $126.86 | $238.30 | $592.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.81 / $136.86 / $295.95
| Professional | | $110.81 | $136.86 | $295.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.28 / $173.63 / $374.79
| Professional | | $104.28 | $173.63 | $374.79 |