- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.65 / $141.59 / $208.06
| Professional | | $93.65 | $141.59 | $208.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.94 / $325.94 / $325.94
| Professional | | $325.94 | $325.94 | $325.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.36 / $235.89 / $517.99
| Professional | | $155.36 | $235.89 | $517.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.82 / $271.77 / $1,760.08
| Professional | | $150.82 | $271.77 | $1,760.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.63 / $211.11 / $375.29
| Professional | | $143.63 | $211.11 | $375.29 |