- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.16 / $78.39 / $103.38
| Professional | | $76.16 | $78.39 | $103.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.19 / $119.28 / $326.77
| Professional | | $101.19 | $119.28 | $326.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.98 / $111.20 / $198.84
| Professional | | $78.98 | $111.20 | $198.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.52 / $118.17 / $198.84
| Professional | | $89.52 | $118.17 | $198.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.64 / $119.74 / $363.08
| Professional | | $112.64 | $119.74 | $363.08 |