- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.16 / $152.33 / $185.36
| Professional | | $132.16 | $152.33 | $185.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.18 / $279.01 / $452.37
| Professional | | $114.18 | $279.01 | $452.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.36 / $229.68 / $360.45
| Professional | | $146.36 | $229.68 | $360.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.72 / $215.49 / $430.60
| Professional | | $130.72 | $215.49 | $430.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.80 / $201.24 / $319.30
| Professional | | $154.80 | $201.24 | $319.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.78 / $139.60 / $209.53
| Professional | | $118.78 | $139.60 | $209.53 |