- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.78 / $128.34 / $211.09
| Professional | | $96.78 | $128.34 | $211.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.95 / $153.41 / $518.04
| Professional | | $77.95 | $153.41 | $518.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.28 / $148.97 / $209.39
| Professional | | $104.28 | $148.97 | $209.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.52 / $114.54 / $462.83
| Professional | | $77.52 | $114.54 | $462.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.98 / $119.19 / $245.03
| Professional | | $68.98 | $119.19 | $245.03 |