- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $147.91 / $245.47
| Professional | | $97.72 | $147.91 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $125.89 / $186.21
| Professional | | $125.89 | $125.89 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $165.96 / $275.42
| Professional | | $102.33 | $165.96 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $186.21 / $1,122.02
| Professional | | $144.54 | $186.21 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $144.54 / $213.80
| Professional | | $102.33 | $144.54 | $213.80 |