- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.32 / $137.82 / $202.21
| Professional | | $126.32 | $137.82 | $202.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.47 / $269.62 / $317.20
| Professional | | $236.47 | $269.62 | $317.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.65 / $261.08 / $396.63
| Professional | | $189.65 | $261.08 | $396.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.43 / $230.87 / $310.93
| Professional | | $115.43 | $230.87 | $310.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.88 / $233.80 / $322.76
| Professional | | $118.88 | $233.80 | $322.76 |