- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.92 / $109.42 / $160.43
| Professional | | $91.92 | $109.42 | $160.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.31 / $158.69 / $328.41
| Professional | | $119.31 | $158.69 | $328.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.03 / $118.80 / $148.82
| Professional | | $93.03 | $118.80 | $148.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.27 / $136.79 / $152.01
| Professional | | $119.27 | $136.79 | $152.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.92 / $105.51 / $154.29
| Professional | | $71.92 | $105.51 | $154.29 |