- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.88 / $111.51 / $174.09
| Professional | | $76.88 | $111.51 | $174.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.81 / $154.55 / $237.00
| Professional | | $102.81 | $154.55 | $237.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.82 / $116.35 / $143.49
| Professional | | $95.82 | $116.35 | $143.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.59 / $169.58 / $194.61
| Professional | | $149.59 | $169.58 | $194.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.09 / $118.77 / $188.21
| Professional | | $93.09 | $118.77 | $188.21 |