- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $144.54 / $251.19
| Professional | | $95.50 | $144.54 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $426.58
| Professional | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $141.25 / $389.05
| Professional | | $58.88 | $141.25 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $154.88 / $354.81
| Professional | | $87.10 | $154.88 | $354.81 |