- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.55 / $169.37 / $507.74
| Professional | | $84.55 | $169.37 | $507.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.00 / $297.00 / $1,375.25
| Professional | | $297.00 | $297.00 | $1,375.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.08 / $186.65 / $301.27
| Professional | | $103.08 | $186.65 | $301.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.90 / $186.49 / $405.24
| Professional | | $140.90 | $186.49 | $405.24 |