- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.27 / $696.10 / $825.76
| Professional | | $79.27 | $696.10 | $825.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.71 / $544.91 / $1,221.90
| Professional | | $108.71 | $544.91 | $1,221.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $175.04 / $901.19
| Professional | | $32.34 | $175.04 | $901.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.63 / $544.91 / $1,337.80
| Professional | | $98.63 | $544.91 | $1,337.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.06 / $1,155.96 / $1,708.29
| Professional | | $845.06 | $1,155.96 | $1,708.29 |