- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.35 / $116.41 / $167.18
| Professional | | $88.35 | $116.41 | $167.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.25 / $128.06 / $139.59
| Professional | | $115.25 | $128.06 | $139.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.00 / $204.99 / $575.72
| Professional | | $111.00 | $204.99 | $575.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.15 / $121.86 / $276.41
| Professional | | $91.15 | $121.86 | $276.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.56 / $124.63 / $350.03
| Professional | | $104.56 | $124.63 | $350.03 |