- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $120.23 / $218.78
| Professional | | $87.10 | $120.23 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $275.42
| Professional | | $144.54 | $144.54 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $114.82 / $269.15
| Professional | | $66.07 | $114.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Professional | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $144.54 / $234.42
| Professional | | $134.90 | $144.54 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $141.25 / $309.03
| Professional | | $75.86 | $141.25 | $309.03 |