- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.72 / $236.71 / $969.26
| Professional | | $129.72 | $236.71 | $969.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.53 / $328.53 / $1,161.49
| Professional | | $328.53 | $328.53 | $1,161.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.43 / $326.31 / $1,161.49
| Professional | | $170.43 | $326.31 | $1,161.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.82 / $335.10 / $1,161.49
| Professional | | $206.82 | $335.10 | $1,161.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.11 / $428.43 / $1,425.60
| Professional | | $244.11 | $428.43 | $1,425.60 |