- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.86 / $123.27 / $188.21
| Professional | | $84.86 | $123.27 | $188.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.38 / $181.36 / $547.48
| Professional | | $149.38 | $181.36 | $547.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.22 / $138.81 / $373.60
| Professional | | $92.22 | $138.81 | $373.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.55 / $184.58 / $373.60
| Professional | | $110.55 | $184.58 | $373.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.32 / $165.96 / $520.62
| Professional | | $134.32 | $165.96 | $520.62 |