- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $295.12 / $954.99
| Professional | | $75.86 | $295.12 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $204.17 / $1,348.96
| Professional | | $72.44 | $204.17 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $275.42 / $1,862.09
| Professional | | $102.33 | $275.42 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $724.44 / $1,621.81
| Professional | | $87.10 | $724.44 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $724.44 / $1,995.26
| Professional | | $112.20 | $724.44 | $1,995.26 |