- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.92 / $107.12 / $194.66
| Professional | | $89.92 | $107.12 | $194.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.16 / $145.96 / $173.33
| Professional | | $120.16 | $145.96 | $173.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.09 / $128.51 / $217.37
| Professional | | $93.09 | $128.51 | $217.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.57 / $130.18 / $897.92
| Professional | | $96.57 | $130.18 | $897.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.32 / $114.09 / $218.40
| Professional | | $94.32 | $114.09 | $218.40 |