- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.06 / $89.89 / $274.62
| Professional | | $73.06 | $89.89 | $274.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.36 / $176.28 / $505.86
| Professional | | $100.36 | $176.28 | $505.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.91 / $375.72 / $929.68
| Professional | | $162.91 | $375.72 | $929.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.23 / $336.60 / $1,038.92
| Professional | | $112.23 | $336.60 | $1,038.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.06 / $560.44 / $1,021.45
| Professional | | $408.06 | $560.44 | $1,021.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.70 / $101.79 / $286.89
| Professional | | $72.70 | $101.79 | $286.89 |