- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.73 / $166.07 / $248.17
| Professional | | $112.73 | $166.07 | $248.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.86 / $168.76 / $249.50
| Professional | | $117.86 | $168.76 | $249.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.72 / $114.12 / $148.82
| Professional | | $91.72 | $114.12 | $148.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.85 / $204.02 / $268.91
| Professional | | $150.85 | $204.02 | $268.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.91 / $183.80 / $305.27
| Professional | | $139.91 | $183.80 | $305.27 |