- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.12 / $128.63 / $164.21
| Professional | | $86.12 | $128.63 | $164.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.46 / $156.54 / $252.66
| Professional | | $121.46 | $156.54 | $252.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.98 / $193.93 / $330.43
| Professional | | $117.98 | $193.93 | $330.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.63 / $273.95 / $1,244.64
| Professional | | $140.63 | $273.95 | $1,244.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.58 / $198.80 / $325.55
| Professional | | $139.58 | $198.80 | $325.55 |