- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.25 / $322.10 / $515.36
| Professional | | $217.25 | $322.10 | $515.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.01 / $264.69 / $410.48
| Professional | | $132.01 | $264.69 | $410.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.26 / $343.72 / $540.73
| Professional | | $230.26 | $343.72 | $540.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.24 / $212.06 / $354.09
| Professional | | $32.24 | $212.06 | $354.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.33 / $376.79 / $900.09
| Professional | | $279.33 | $376.79 | $900.09 |