- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $138.04 / $218.78
| Professional | | $95.50 | $138.04 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $81.28 / $131.83
| Professional | | $69.18 | $81.28 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $131.83 / $154.88
| Professional | | $91.20 | $131.83 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $169.82 / $741.31
| Professional | | $100.00 | $169.82 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $141.25 / $234.42
| Professional | | $91.20 | $141.25 | $234.42 |