- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.41 / $104.34 / $140.24
| Professional | | $83.41 | $104.34 | $140.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.05 / $120.06 / $130.87
| Professional | | $108.05 | $120.06 | $130.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.03 / $124.00 / $302.76
| Professional | | $92.03 | $124.00 | $302.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.64 / $102.94 / $266.77
| Professional | | $83.64 | $102.94 | $266.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.09 / $132.33 / $315.75
| Professional | | $97.09 | $132.33 | $315.75 |