- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.75 / $115.70 / $305.57
| Professional | | $79.75 | $115.70 | $305.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.36 / $130.44 / $170.79
| Professional | | $104.36 | $130.44 | $170.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.35 / $126.42 / $207.84
| Professional | | $83.35 | $126.42 | $207.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.82 / $140.06 / $934.48
| Professional | | $103.82 | $140.06 | $934.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.32 / $122.50 / $238.51
| Professional | | $101.32 | $122.50 | $238.51 |