- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.84 / $135.71 / $280.64
| Professional | | $97.84 | $135.71 | $280.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.89 / $204.85 / $280.33
| Professional | | $106.89 | $204.85 | $280.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.57 / $224.56 / $343.39
| Professional | | $150.57 | $224.56 | $343.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.32 / $199.42 / $249.75
| Professional | | $125.32 | $199.42 | $249.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.64 / $235.58 / $408.86
| Professional | | $125.64 | $235.58 | $408.86 |