- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.15 / $249.29 / $270.42
| Professional | | $75.15 | $249.29 | $270.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.70 / $244.18 / $1,164.78
| Professional | | $187.70 | $244.18 | $1,164.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.29 / $535.24 / $1,178.33
| Professional | | $261.29 | $535.24 | $1,178.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.59 / $307.39 / $620.44
| Professional | | $250.59 | $307.39 | $620.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.84 / $111.79 / $626.34
| Professional | | $64.84 | $111.79 | $626.34 |