- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.61 / $140.26 / $272.06
| Professional | | $93.61 | $140.26 | $272.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.19 / $129.83 / $148.40
| Professional | | $126.19 | $129.83 | $148.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.30 / $177.25 / $370.58
| Professional | | $111.30 | $177.25 | $370.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.63 / $228.27 / $371.47
| Professional | | $171.63 | $228.27 | $371.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.01 / $180.88 / $304.82
| Professional | | $121.01 | $180.88 | $304.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.97 / $197.37 / $243.51
| Professional | | $130.97 | $197.37 | $243.51 |