- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.77 / $138.11 / $557.36
| Professional | | $96.77 | $138.11 | $557.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.23 / $166.31 / $265.93
| Professional | | $118.23 | $166.31 | $265.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.29 / $151.64 / $187.67
| Professional | | $117.29 | $151.64 | $187.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.91 / $209.36 / $326.43
| Professional | | $140.91 | $209.36 | $326.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.90 / $145.08 / $237.77
| Professional | | $120.90 | $145.08 | $237.77 |