- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.45 / $236.37 / $286.14
| Professional | | $38.45 | $236.37 | $286.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.62 / $170.78 / $212.99
| Professional | | $136.62 | $170.78 | $212.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.56 / $469.93 / $1,030.14
| Professional | | $204.56 | $469.93 | $1,030.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.53 / $269.89 / $541.19
| Professional | | $218.53 | $269.89 | $541.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.51 / $59.04 / $519.01
| Professional | | $38.51 | $59.04 | $519.01 |