- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.92 / $129.63 / $180.80
| Professional | | $108.92 | $129.63 | $180.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.80 / $168.66 / $296.77
| Professional | | $109.80 | $168.66 | $296.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.00 / $110.00 / $238.76
| Professional | | $110.00 | $110.00 | $238.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.29 / $161.54 / $264.81
| Professional | | $122.29 | $161.54 | $264.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.30 / $124.79 / $244.42
| Professional | | $87.30 | $124.79 | $244.42 |