- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.91 / $135.12 / $193.26
| Professional | | $105.91 | $135.12 | $193.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.76 / $158.44 / $247.05
| Professional | | $126.76 | $158.44 | $247.05 |
- 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
- $135.03 / $175.62 / $199.49
| Professional | | $135.03 | $175.62 | $199.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.50 / $135.24 / $204.76
| Professional | | $103.50 | $135.24 | $204.76 |