- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.14 / $114.99 / $144.12
| Professional | | $82.14 | $114.99 | $144.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $91.37 / $121.52
| Professional | | $77.62 | $91.37 | $121.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.14 / $176.70 / $331.32
| Professional | | $73.14 | $176.70 | $331.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.04 / $258.60 / $258.60
| Professional | | $143.04 | $258.60 | $258.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.23 / $144.46 / $313.56
| Professional | | $91.23 | $144.46 | $313.56 |