- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.09 / $118.44 / $254.46
| Professional | | $39.09 | $118.44 | $254.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.17 / $148.55 / $293.51
| Professional | | $47.17 | $148.55 | $293.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.21 / $143.96 / $185.53
| Professional | | $114.21 | $143.96 | $185.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.81 / $88.85 / $286.48
| Professional | | $58.81 | $88.85 | $286.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.05 / $176.80 / $293.70
| Professional | | $129.05 | $176.80 | $293.70 |