- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.52 / $130.82 / $340.78
| Professional | | $92.52 | $130.82 | $340.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.79 / $149.28 / $210.27
| Professional | | $108.79 | $149.28 | $210.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.77 / $86.85 / $115.57
| Professional | | $68.77 | $86.85 | $115.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.75 / $162.30 / $195.84
| Professional | | $114.75 | $162.30 | $195.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.55 / $122.84 / $181.01
| Professional | | $94.55 | $122.84 | $181.01 |