- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.97 / $93.17 / $126.73
| Professional | | $73.97 | $93.17 | $126.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.04 / $192.25 / $232.37
| Professional | | $151.04 | $192.25 | $232.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.32 / $129.15 / $163.13
| Professional | | $103.32 | $129.15 | $163.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.27 / $556.79 / $660.93
| Professional | | $131.27 | $556.79 | $660.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.16 / $196.38 / $220.66
| Professional | | $111.16 | $196.38 | $220.66 |