- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.87 / $143.69 / $208.01
| Professional | | $123.87 | $143.69 | $208.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.39 / $164.78 / $232.85
| Professional | | $127.39 | $164.78 | $232.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.89 / $100.12 / $131.97
| Professional | | $74.89 | $100.12 | $131.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.55 / $179.53 / $211.29
| Professional | | $140.55 | $179.53 | $211.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.39 / $151.60 / $275.75
| Professional | | $126.39 | $151.60 | $275.75 |