- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.27 / $158.44 / $245.20
| Professional | | $92.27 | $158.44 | $245.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.37 / $148.30 / $208.72
| Professional | | $105.37 | $148.30 | $208.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.97 / $206.02 / $249.72
| Professional | | $141.97 | $206.02 | $249.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $176.02 / $221.44
| Professional | | $32.34 | $176.02 | $221.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.13 / $201.79 / $257.18
| Professional | | $150.13 | $201.79 | $257.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.86 / $176.97 / $256.77
| Professional | | $131.86 | $176.97 | $256.77 |