- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $123.03 / $213.80
| Professional | | $93.33 | $123.03 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $186.21 / $245.47
| Professional | | $97.72 | $186.21 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $158.49 / $338.84
| Professional | | $107.15 | $158.49 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $144.54 / $173.78
| Professional | | $104.71 | $144.54 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $131.83 / $281.84
| Professional | | $97.72 | $131.83 | $281.84 |