- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.86 / $138.09 / $336.81
| Professional | | $118.86 | $138.09 | $336.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.40 / $133.55 / $225.83
| Professional | | $105.40 | $133.55 | $225.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.77 / $161.61 / $291.04
| Professional | | $116.77 | $161.61 | $291.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.28 / $173.97 / $784.05
| Professional | | $112.28 | $173.97 | $784.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.37 / $164.82 / $312.67
| Professional | | $107.37 | $164.82 | $312.67 |