- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.90 / $81.06 / $115.16
| Professional | | $77.90 | $81.06 | $115.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.24 / $137.03 / $354.64
| Professional | | $116.24 | $137.03 | $354.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.25 / $130.97 / $220.06
| Professional | | $89.25 | $130.97 | $220.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.12 / $136.50 / $220.06
| Professional | | $96.12 | $136.50 | $220.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.56 / $135.03 / $401.82
| Professional | | $116.56 | $135.03 | $401.82 |