- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.55 / $552.79 / $948.96
| Professional | | $75.55 | $552.79 | $948.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.40 / $661.78 / $2,216.37
| Professional | | $89.40 | $661.78 | $2,216.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.41 / $944.10 / $1,160.76
| Professional | | $148.41 | $944.10 | $1,160.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.77 / $689.85 / $1,199.88
| Professional | | $66.77 | $689.85 | $1,199.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.53 / $761.18 / $1,798.54
| Professional | | $485.53 | $761.18 | $1,798.54 |