- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.68 / $155.29 / $213.10
| Professional | | $118.68 | $155.29 | $213.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.72 / $186.86 / $263.68
| Professional | | $133.72 | $186.86 | $263.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.77 / $86.94 / $115.57
| Professional | | $68.77 | $86.94 | $115.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.29 / $202.03 / $242.19
| Professional | | $142.29 | $202.03 | $242.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.12 / $161.07 / $237.18
| Professional | | $120.12 | $161.07 | $237.18 |