- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.79 / $109.39 / $402.47
| Professional | | $95.79 | $109.39 | $402.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.27 / $103.64 / $213.82
| Professional | | $73.27 | $103.64 | $213.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $80.64 / $94.87
| Professional | | $60.00 | $80.64 | $94.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.43 / $130.47 / $153.44
| Professional | | $117.43 | $130.47 | $153.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $103.60 / $162.81
| Professional | | $91.20 | $103.60 | $162.81 |