- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.93 / $129.46 / $262.95
| Professional | | $93.93 | $129.46 | $262.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.10 / $205.34 / $249.45
| Professional | | $94.10 | $205.34 | $249.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.20 / $161.57 / $337.69
| Professional | | $108.20 | $161.57 | $337.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.48 / $159.19 / $217.93
| Professional | | $126.48 | $159.19 | $217.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.21 / $156.08 / $294.60
| Professional | | $101.21 | $156.08 | $294.60 |