- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.27 / $135.94 / $232.34
| Professional | | $96.27 | $135.94 | $232.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.51 / $221.66 / $309.77
| Professional | | $146.51 | $221.66 | $309.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.79 / $91.70 / $129.38
| Professional | | $31.79 | $91.70 | $129.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.88 / $293.74 / $384.16
| Professional | | $202.88 | $293.74 | $384.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.40 / $179.10 / $254.13
| Professional | | $119.40 | $179.10 | $254.13 |