- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.53 / $63.61 / $434.54
| Professional | | $44.53 | $63.61 | $434.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.68 / $456.68 / $945.80
| Professional | | $456.68 | $456.68 | $945.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.17 / $253.05 / $806.89
| Professional | | $75.17 | $253.05 | $806.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.63 / $262.50 / $744.30
| Professional | | $77.63 | $262.50 | $744.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.66 / $474.89 / $1,160.86
| Professional | | $426.66 | $474.89 | $1,160.86 |