- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.34 / $130.71 / $224.78
| Professional | | $111.34 | $130.71 | $224.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.83 / $207.43 / $514.54
| Professional | | $99.83 | $207.43 | $514.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.43 / $204.04 / $242.22
| Professional | | $150.43 | $204.04 | $242.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.24 / $146.34 / $250.58
| Professional | | $103.24 | $146.34 | $250.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.91 / $132.30 / $263.45
| Professional | | $96.91 | $132.30 | $263.45 |