- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $524.81 / $954.99
| Professional | | $79.43 | $524.81 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $602.56 / $1,071.52
| Professional | | $74.13 | $602.56 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $380.19 / $1,288.25
| Professional | | $95.50 | $380.19 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $537.03 / $1,148.15
| Professional | | $81.28 | $537.03 | $1,148.15 |