- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.21 / $186.33 / $229.68
| Professional | | $151.21 | $186.33 | $229.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.57 / $183.06 / $259.07
| Professional | | $144.57 | $183.06 | $259.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.72 / $112.56 / $143.55
| Professional | | $92.72 | $112.56 | $143.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.34 / $187.98 / $223.65
| Professional | | $158.34 | $187.98 | $223.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.31 / $160.80 / $293.02
| Professional | | $134.31 | $160.80 | $293.02 |