- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $193.05 / $568.50
| Professional | | $112.20 | $193.05 | $568.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.04 / $189.46 / $271.79
| Professional | | $147.04 | $189.46 | $271.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.77 / $86.94 / $115.57
| Professional | | $68.77 | $86.94 | $115.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.41 / $198.20 / $239.41
| Professional | | $148.41 | $198.20 | $239.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.45 / $161.94 / $234.43
| Professional | | $122.45 | $161.94 | $234.43 |