- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.20 / $153.58 / $353.21
| Professional | | $71.20 | $153.58 | $353.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.09 / $620.09 / $620.09
| Professional | | $620.09 | $620.09 | $620.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.88 / $203.75 / $536.47
| Professional | | $100.88 | $203.75 | $536.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.53 / $282.89 / $425.04
| Professional | | $114.53 | $282.89 | $425.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.16 / $312.72 / $761.09
| Professional | | $194.16 | $312.72 | $761.09 |