- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.98 / $144.25 / $595.21
| Professional | | $98.98 | $144.25 | $595.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.97 / $149.93 / $212.17
| Professional | | $128.97 | $149.93 | $212.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.10 / $161.74 / $277.58
| Professional | | $108.10 | $161.74 | $277.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.21 / $181.86 / $1,244.64
| Professional | | $123.21 | $181.86 | $1,244.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.88 / $155.88 / $312.54
| Professional | | $119.88 | $155.88 | $312.54 |