- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.25 / $122.04 / $180.80
| Professional | | $113.25 | $122.04 | $180.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.19 / $170.65 / $263.93
| Professional | | $108.19 | $170.65 | $263.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.33 / $186.57 / $309.30
| Professional | | $140.33 | $186.57 | $309.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.24 / $222.79 / $281.52
| Professional | | $153.24 | $222.79 | $281.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.31 / $170.91 / $325.86
| Professional | | $118.31 | $170.91 | $325.86 |