- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.76 / $108.46 / $198.63
| Professional | | $86.76 | $108.46 | $198.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.35 / $184.31 / $379.87
| Professional | | $156.35 | $184.31 | $379.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.74 / $163.59 / $184.42
| Professional | | $94.74 | $163.59 | $184.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.73 / $156.68 / $184.42
| Professional | | $90.73 | $156.68 | $184.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.07 / $143.72 / $425.55
| Professional | | $125.07 | $143.72 | $425.55 |