- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.75 / $108.57 / $143.07
| Professional | | $79.75 | $108.57 | $143.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.70 / $82.29 / $116.58
| Professional | | $69.70 | $82.29 | $116.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.84 / $137.81 / $206.72
| Professional | | $114.84 | $137.81 | $206.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.48 / $127.05 / $206.72
| Professional | | $93.48 | $127.05 | $206.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.54 / $126.13 / $231.68
| Professional | | $97.54 | $126.13 | $231.68 |