- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.43 / $96.78 / $136.47
| Professional | | $56.43 | $96.78 | $136.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.89 / $94.66 / $193.13
| Professional | | $50.89 | $94.66 | $193.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.03 / $105.15 / $201.05
| Professional | | $57.03 | $105.15 | $201.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.71 / $782.75 / $1,010.85
| Professional | | $451.71 | $782.75 | $1,010.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.06 / $107.38 / $143.90
| Professional | | $74.06 | $107.38 | $143.90 |