- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.46 / $135.12 / $192.99
| Professional | | $111.46 | $135.12 | $192.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.07 / $203.21 / $419.47
| Professional | | $120.07 | $203.21 | $419.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.85 / $218.13 / $268.26
| Professional | | $165.85 | $218.13 | $268.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.42 / $149.32 / $243.05
| Professional | | $94.42 | $149.32 | $243.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.73 / $157.18 / $325.42
| Professional | | $105.73 | $157.18 | $325.42 |