- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $112.20 / $245.47
| Professional | | $77.62 | $112.20 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $102.33 / $977.24
| Professional | | $74.13 | $102.33 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $173.78 / $281.84
| Professional | | $89.13 | $173.78 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $199.53 / $295.12
| Professional | | $151.36 | $199.53 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $134.90 / $263.03
| Professional | | $75.86 | $134.90 | $263.03 |