- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.88 / $116.42 / $180.67
| Professional | | $87.88 | $116.42 | $180.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.95 / $176.33 / $387.62
| Professional | | $95.95 | $176.33 | $387.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.41 / $212.06 / $260.72
| Professional | | $161.41 | $212.06 | $260.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.31 / $132.91 / $212.10
| Professional | | $77.31 | $132.91 | $212.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.43 / $128.56 / $294.25
| Professional | | $88.43 | $128.56 | $294.25 |