- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $229.09 / $575.44
| Professional | | $151.36 | $229.09 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $537.03 / $2,344.23
| Professional | | $87.10 | $537.03 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $245.47 / $524.81
| Professional | | $186.21 | $245.47 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $190.55 / $446.68
| Professional | | $177.83 | $190.55 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $251.19 / $501.19
| Professional | | $165.96 | $251.19 | $501.19 |