- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $123.03 / $186.21
| Professional | | $93.33 | $123.03 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $112.20 / $1,380.38
| Professional | | $97.72 | $112.20 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $120.23 / $371.54
| Professional | | $91.20 | $120.23 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $95.50 / $234.42
| Professional | | $91.20 | $95.50 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $112.20 / $269.15
| Professional | | $81.28 | $112.20 | $269.15 |