- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.68 / $103.08 / $116.12
| Professional | | $92.68 | $103.08 | $116.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.13 / $79.64 / $317.05
| Professional | | $70.13 | $79.64 | $317.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.54 / $132.53 / $271.85
| Professional | | $81.54 | $132.53 | $271.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.27 / $130.47 / $246.55
| Professional | | $101.27 | $130.47 | $246.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.06 / $131.12 / $255.09
| Professional | | $89.06 | $131.12 | $255.09 |