- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.56 / $184.41 / $368.12
| Professional | | $75.56 | $184.41 | $368.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.32 / $325.72 / $681.72
| Professional | | $276.32 | $325.72 | $681.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.36 / $203.60 / $351.23
| Professional | | $98.36 | $203.60 | $351.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.00 / $203.60 / $351.23
| Professional | | $80.00 | $203.60 | $351.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.17 / $258.43 / $751.26
| Professional | | $248.17 | $258.43 | $751.26 |