- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.30 / $198.63 / $420.01
| Professional | | $79.30 | $198.63 | $420.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.38 / $191.77 / $406.35
| Professional | | $99.38 | $191.77 | $406.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.88 / $176.45 / $225.87
| Professional | | $138.88 | $176.45 | $225.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.47 / $247.45 / $361.33
| Professional | | $114.47 | $247.45 | $361.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.30 / $244.96 / $381.48
| Professional | | $168.30 | $244.96 | $381.48 |