- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.46 / $126.74 / $194.04
| Professional | | $103.46 | $126.74 | $194.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.70 / $128.69 / $220.88
| Professional | | $98.70 | $128.69 | $220.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.29 / $134.16 / $255.20
| Professional | | $105.29 | $134.16 | $255.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.72 / $779.72 / $949.58
| Professional | | $779.72 | $779.72 | $949.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.61 / $128.25 / $203.50
| Professional | | $99.61 | $128.25 | $203.50 |