- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.40 / $105.52 / $144.71
| Professional | | $74.40 | $105.52 | $144.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.24 / $128.85 / $197.80
| Professional | | $88.24 | $128.85 | $197.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.62 / $128.86 / $275.77
| Professional | | $87.62 | $128.86 | $275.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.16 / $896.56 / $1,032.68
| Professional | | $684.16 | $896.56 | $1,032.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.34 / $135.93 / $259.69
| Professional | | $114.34 | $135.93 | $259.69 |