- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.36 / $92.59 / $138.99
| Professional | | $92.36 | $92.59 | $138.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.36 / $143.06 / $429.91
| Professional | | $121.36 | $143.06 | $429.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.77 / $152.63 / $241.25
| Professional | | $101.77 | $152.63 | $241.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.53 / $144.52 / $212.87
| Professional | | $102.53 | $144.52 | $212.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.28 / $151.52 / $440.49
| Professional | | $146.28 | $151.52 | $440.49 |