- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.04 / $238.55 / $603.63
| Professional | | $118.04 | $238.55 | $603.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.41 / $174.23 / $344.38
| Professional | | $100.41 | $174.23 | $344.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.41 / $268.04 / $466.10
| Professional | | $130.41 | $268.04 | $466.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.19 / $381.40 / $438.90
| Professional | | $312.19 | $381.40 | $438.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.01 / $324.39 / $584.58
| Professional | | $246.01 | $324.39 | $584.58 |