- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.45 / $103.46 / $142.94
| Professional | | $71.45 | $103.46 | $142.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.37 / $89.86 / $146.69
| Professional | | $85.37 | $89.86 | $146.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.37 / $231.73 / $555.39
| Professional | | $102.37 | $231.73 | $555.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.14 / $120.14 / $319.80
| Professional | | $87.14 | $120.14 | $319.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.31 / $249.82 / $337.59
| Professional | | $100.31 | $249.82 | $337.59 |