- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.79 / $134.78 / $159.85
| Professional | | $112.79 | $134.78 | $159.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.91 / $150.27 / $235.42
| Professional | | $123.91 | $150.27 | $235.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.78 / $151.22 / $197.67
| Professional | | $131.78 | $151.22 | $197.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.94 / $170.23 / $312.98
| Professional | | $118.94 | $170.23 | $312.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.07 / $166.86 / $282.19
| Professional | | $134.07 | $166.86 | $282.19 |