- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.06 / $238.54 / $281.43
| Professional | | $78.06 | $238.54 | $281.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.60 / $316.26 / $801.58
| Professional | | $103.60 | $316.26 | $801.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.51 / $459.77 / $565.08
| Professional | | $162.51 | $459.77 | $565.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.50 / $271.75 / $455.46
| Professional | | $75.50 | $271.75 | $455.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.96 / $302.89 / $666.26
| Professional | | $176.96 | $302.89 | $666.26 |