- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $112.20 / $223.87
| Professional | | $95.50 | $112.20 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $125.89 / $147.91
| Professional | | $93.33 | $125.89 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $138.04 / $186.21
| Professional | | $102.33 | $138.04 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $128.82 / $891.25
| Professional | | $95.50 | $128.82 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $107.15 / $147.91
| Professional | | $83.18 | $107.15 | $147.91 |