- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.98 / $150.22 / $163.43
| Professional | | $98.98 | $150.22 | $163.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.46 / $266.30 / $377.21
| Professional | | $206.46 | $266.30 | $377.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.41 / $269.68 / $475.75
| Professional | | $144.41 | $269.68 | $475.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.02 / $280.18 / $393.14
| Professional | | $153.02 | $280.18 | $393.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.13 / $285.97 / $393.14
| Professional | | $164.13 | $285.97 | $393.14 |