- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.92 / $116.55 / $258.48
| Professional | | $89.92 | $116.55 | $258.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.21 / $190.09 / $262.64
| Professional | | $94.21 | $190.09 | $262.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.84 / $197.18 / $291.32
| Professional | | $140.84 | $197.18 | $291.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.71 / $157.00 / $204.53
| Professional | | $105.71 | $157.00 | $204.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.29 / $212.28 / $355.80
| Professional | | $103.29 | $212.28 | $355.80 |