- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.49 / $126.58 / $153.86
| Professional | | $114.49 | $126.58 | $153.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.05 / $159.41 / $253.60
| Professional | | $120.05 | $159.41 | $253.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.93 / $65.67 / $98.49
| Professional | | $49.93 | $65.67 | $98.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.00 / $182.09 / $251.31
| Professional | | $140.00 | $182.09 | $251.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.60 / $151.19 / $205.84
| Professional | | $101.60 | $151.19 | $205.84 |