- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $173.78 / $616.60
| Professional | | $109.65 | $173.78 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $190.55 / $338.84
| Professional | | $131.83 | $190.55 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $208.93 / $346.74
| Professional | | $151.36 | $208.93 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $169.82 / $208.93
| Professional | | $117.49 | $169.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $186.21 / $295.12
| Professional | | $112.20 | $186.21 | $295.12 |