- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.47 / $161.87 / $247.06
| Professional | | $160.47 | $161.87 | $247.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.72 / $172.81 / $226.98
| Professional | | $145.72 | $172.81 | $226.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.54 / $83.96 / $113.84
| Professional | | $70.54 | $83.96 | $113.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.96 / $180.83 / $210.20
| Professional | | $157.96 | $180.83 | $210.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.83 / $145.08 / $252.71
| Professional | | $115.83 | $145.08 | $252.71 |