- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.27 / $161.19 / $298.52
| Professional | | $146.27 | $161.19 | $298.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.55 / $116.55 / $116.55
| Professional | | $116.55 | $116.55 | $116.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.72 / $217.66 / $335.84
| Professional | | $154.72 | $217.66 | $335.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.87 / $150.97 / $589.03
| Professional | | $98.87 | $150.97 | $589.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,308.32 / $1,347.57 / $1,347.57
| Professional | | $1,308.32 | $1,347.57 | $1,347.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.04 / $201.46 / $351.17
| Professional | | $151.04 | $201.46 | $351.17 |