- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.06 / $111.91 / $184.85
| Professional | | $81.06 | $111.91 | $184.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.82 / $149.41 / $322.77
| Professional | | $92.82 | $149.41 | $322.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.18 / $180.50 / $204.70
| Professional | | $111.18 | $180.50 | $204.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.43 / $132.77 / $245.94
| Professional | | $81.43 | $132.77 | $245.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.32 / $158.44 / $364.78
| Professional | | $102.32 | $158.44 | $364.78 |