- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.62 / $166.24 / $375.82
| Professional | | $74.62 | $166.24 | $375.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.42 / $201.30 / $481.21
| Professional | | $98.42 | $201.30 | $481.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.49 / $233.87 / $511.47
| Professional | | $112.49 | $233.87 | $511.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.51 / $342.05 / $621.45
| Professional | | $234.51 | $342.05 | $621.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.48 / $318.68 / $857.03
| Professional | | $182.48 | $318.68 | $857.03 |