- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $143.47 / $236.95
| Professional | | $87.10 | $143.47 | $236.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.36 / $170.32 / $513.95
| Professional | | $144.36 | $170.32 | $513.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.24 / $153.56 / $406.94
| Professional | | $95.24 | $153.56 | $406.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.96 / $196.54 / $406.94
| Professional | | $124.96 | $196.54 | $406.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.35 / $185.18 / $575.04
| Professional | | $148.35 | $185.18 | $575.04 |