- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.14 / $100.31 / $119.92
| Professional | | $81.14 | $100.31 | $119.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.68 / $150.41 / $265.89
| Professional | | $130.68 | $150.41 | $265.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.73 / $162.78 / $311.98
| Professional | | $119.73 | $162.78 | $311.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.60 / $224.40 / $461.74
| Professional | | $149.60 | $224.40 | $461.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.25 / $172.55 / $328.63
| Professional | | $102.25 | $172.55 | $328.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.38 / $106.06 / $155.90
| Professional | | $88.38 | $106.06 | $155.90 |