- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.87 / $444.57 / $1,169.80
| Professional | | $82.87 | $444.57 | $1,169.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.75 / $88.63 / $146.61
| Professional | | $22.75 | $88.63 | $146.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.94 / $255.86 / $1,710.21
| Professional | | $69.94 | $255.86 | $1,710.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.70 / $912.86 / $1,322.92
| Professional | | $108.70 | $912.86 | $1,322.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.67 / $873.58 / $1,262.51
| Professional | | $697.67 | $873.58 | $1,262.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.35 / $1,131.58 / $1,548.84
| Professional | | $136.35 | $1,131.58 | $1,548.84 |