- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.42 / $220.58 / $464.68
| Professional | | $94.42 | $220.58 | $464.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.40 / $427.19 / $1,050.91
| Professional | | $362.40 | $427.19 | $1,050.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.90 / $295.61 / $488.99
| Professional | | $159.90 | $295.61 | $488.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.21 / $295.61 / $476.90
| Professional | | $106.21 | $295.61 | $476.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.12 / $362.01 / $1,164.07
| Professional | | $317.12 | $362.01 | $1,164.07 |