- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $112.20 / $245.47
| Professional | | $75.86 | $112.20 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $169.82 / $251.19
| Professional | | $91.20 | $169.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $181.97 / $302.00
| Professional | | $114.82 | $181.97 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $173.78 / $288.40
| Professional | | $144.54 | $173.78 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $144.54 / $295.12
| Professional | | $81.28 | $144.54 | $295.12 |