- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.67 / $123.03 / $185.15
| Professional | | $87.67 | $123.03 | $185.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.50 / $213.50 / $216.88
| Professional | | $213.50 | $213.50 | $216.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.36 / $173.03 / $241.67
| Professional | | $128.36 | $173.03 | $241.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.53 / $245.53 / $249.41
| Professional | | $245.53 | $245.53 | $249.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.30 / $134.33 / $241.93
| Professional | | $104.30 | $134.33 | $241.93 |