- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.79 / $248.47 / $457.19
| Professional | | $83.79 | $248.47 | $457.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.31 / $223.46 / $305.62
| Professional | | $151.31 | $223.46 | $305.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.78 / $487.39 / $1,068.98
| Professional | | $211.78 | $487.39 | $1,068.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.65 / $279.92 / $567.79
| Professional | | $226.65 | $279.92 | $567.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.94 / $55.87 / $544.53
| Professional | | $35.94 | $55.87 | $544.53 |