- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.84 / $127.33 / $204.20
| Professional | | $106.84 | $127.33 | $204.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.06 / $189.02 / $382.84
| Professional | | $115.06 | $189.02 | $382.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.96 / $187.60 / $222.11
| Professional | | $135.96 | $187.60 | $222.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.70 / $96.99 / $162.52
| Professional | | $15.70 | $96.99 | $162.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.53 / $135.21 / $276.08
| Professional | | $87.53 | $135.21 | $276.08 |