- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.30 / $127.40 / $165.89
| Professional | | $104.30 | $127.40 | $165.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.08 / $78.08 / $87.83
| Professional | | $78.08 | $78.08 | $87.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.04 / $134.16 / $134.16
| Professional | | $114.04 | $134.16 | $134.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.43 / $150.40 / $205.87
| Professional | | $106.43 | $150.40 | $205.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.07 / $143.47 / $671.69
| Professional | | $110.07 | $143.47 | $671.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.77 / $132.24 / $203.48
| Professional | | $106.77 | $132.24 | $203.48 |