- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.62 / $102.28 / $212.11
| Professional | | $60.62 | $102.28 | $212.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.23 / $129.38 / $182.46
| Professional | | $81.23 | $129.38 | $182.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.51 / $58.74 / $73.36
| Professional | | $48.51 | $58.74 | $73.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.87 / $168.55 / $216.90
| Professional | | $116.87 | $168.55 | $216.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.70 / $104.72 / $146.80
| Professional | | $74.70 | $104.72 | $146.80 |