- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.33 / $92.80 / $205.20
| Professional | | $74.33 | $92.80 | $205.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.42 / $207.31 / $227.30
| Professional | | $172.42 | $207.31 | $227.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.23 / $175.91 / $303.14
| Professional | | $65.23 | $175.91 | $303.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.75 / $119.54 / $493.60
| Professional | | $60.75 | $119.54 | $493.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.50 / $103.86 / $151.52
| Professional | | $63.50 | $103.86 | $151.52 |