- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.01 / $111.82 / $157.37
| Professional | | $98.01 | $111.82 | $157.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.63 / $249.47 / $365.61
| Professional | | $211.63 | $249.47 | $365.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.40 / $149.07 / $425.21
| Professional | | $103.40 | $149.07 | $425.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.05 / $145.56 / $365.61
| Professional | | $110.05 | $145.56 | $365.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.03 / $155.32 / $429.74
| Professional | | $95.03 | $155.32 | $429.74 |