- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.87 / $464.04 / $913.33
| Professional | | $337.87 | $464.04 | $913.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.70 / $768.75 / $1,542.19
| Professional | | $75.70 | $768.75 | $1,542.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,473.85 / $1,473.85 / $1,473.85
| Professional | | $1,473.85 | $1,473.85 | $1,473.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $36.31 / $714.08
| Professional | | $36.31 | $36.31 | $714.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.57 / $525.54 / $1,015.75
| Professional | | $388.57 | $525.54 | $1,015.75 |