- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.07 / $156.32 / $238.17
| Professional | | $93.07 | $156.32 | $238.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.18 / $179.85 / $275.75
| Professional | | $116.18 | $179.85 | $275.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $126.52 / $225.05
| Professional | | $32.34 | $126.52 | $225.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.90 / $179.85 / $275.75
| Professional | | $119.90 | $179.85 | $275.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.50 / $212.30 / $343.44
| Professional | | $168.50 | $212.30 | $343.44 |