- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.07 / $94.53 / $114.93
| Professional | | $83.07 | $94.53 | $114.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.34 / $106.40 / $148.34
| Professional | | $77.34 | $106.40 | $148.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.15 / $133.16 / $191.84
| Professional | | $88.15 | $133.16 | $191.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.35 / $133.44 / $929.60
| Professional | | $97.35 | $133.44 | $929.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.83 / $119.54 / $168.54
| Professional | | $93.83 | $119.54 | $168.54 |