- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.84 / $192.89 / $568.50
| Professional | | $126.84 | $192.89 | $568.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.59 / $136.22 / $160.38
| Professional | | $119.59 | $136.22 | $160.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.92 / $191.03 / $194.85
| Professional | | $169.92 | $191.03 | $194.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.89 / $159.63 / $263.70
| Professional | | $120.89 | $159.63 | $263.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.76 / $138.79 / $221.48
| Professional | | $109.76 | $138.79 | $221.48 |