- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.85 / $141.69 / $221.70
| Professional | | $105.85 | $141.69 | $221.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.05 / $191.82 / $371.90
| Professional | | $144.05 | $191.82 | $371.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.62 / $181.96 / $237.84
| Professional | | $126.62 | $181.96 | $237.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.18 / $187.55 / $303.19
| Professional | | $146.18 | $187.55 | $303.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.03 / $167.36 / $253.27
| Professional | | $111.03 | $167.36 | $253.27 |