- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.58 / $166.24 / $276.97
| Professional | | $74.58 | $166.24 | $276.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.12 / $205.93 / $553.83
| Professional | | $159.12 | $205.93 | $553.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.48 / $253.36 / $581.96
| Professional | | $114.48 | $253.36 | $581.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.63 / $333.62 / $1,646.32
| Professional | | $194.63 | $333.62 | $1,646.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.15 / $332.25 / $519.53
| Professional | | $178.15 | $332.25 | $519.53 |