- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.15 / $80.38 / $369.02
| Professional | | $67.15 | $80.38 | $369.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.01 / $126.14 / $298.62
| Professional | | $107.01 | $126.14 | $298.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.14 / $116.48 / $144.72
| Professional | | $73.14 | $116.48 | $144.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.00 / $115.81 / $144.72
| Professional | | $65.00 | $115.81 | $144.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.44 / $116.58 / $338.90
| Professional | | $94.44 | $116.58 | $338.90 |