- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.46 / $113.18 / $156.66
| Professional | | $87.46 | $113.18 | $156.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.77 / $85.26 / $85.26
| Professional | | $62.77 | $85.26 | $85.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.67 / $137.90 / $334.28
| Professional | | $80.67 | $137.90 | $334.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.34 / $147.44 / $282.81
| Professional | | $127.34 | $147.44 | $282.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.85 / $106.09 / $324.87
| Professional | | $91.85 | $106.09 | $324.87 |