- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.25 / $116.55 / $175.79
| Professional | | $113.25 | $116.55 | $175.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.40 / $150.57 / $165.33
| Professional | | $120.40 | $150.57 | $165.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.95 / $147.02 / $207.67
| Professional | | $79.95 | $147.02 | $207.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.35 / $141.26 / $784.05
| Professional | | $104.35 | $141.26 | $784.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.38 / $132.09 / $217.95
| Professional | | $100.38 | $132.09 | $217.95 |