- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.25 / $165.45 / $202.21
| Professional | | $113.25 | $165.45 | $202.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.78 / $187.02 / $230.81
| Professional | | $112.78 | $187.02 | $230.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.37 / $114.21 / $143.49
| Professional | | $94.37 | $114.21 | $143.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.15 / $144.15 / $223.35
| Professional | | $127.15 | $144.15 | $223.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.88 / $161.65 / $217.22
| Professional | | $108.88 | $161.65 | $217.22 |