- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.81 / $149.30 / $291.54
| Professional | | $95.81 | $149.30 | $291.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.06 / $287.69 / $650.11
| Professional | | $244.06 | $287.69 | $650.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.80 / $195.62 / $310.08
| Professional | | $152.80 | $195.62 | $310.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.42 / $195.62 / $298.51
| Professional | | $101.42 | $195.62 | $298.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.45 / $221.40 / $719.80
| Professional | | $195.45 | $221.40 | $719.80 |