- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $218.78 / $380.19
| Professional | | $109.65 | $218.78 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $138.04 / $302.00
| Professional | | $131.83 | $138.04 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $204.17 / $457.09
| Professional | | $107.15 | $204.17 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $245.47 / $331.13
| Professional | | $114.82 | $245.47 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $194.98 / $426.58
| Professional | | $83.18 | $194.98 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $204.17 / $295.12
| Professional | | $112.20 | $204.17 | $295.12 |