- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.09 / $148.58 / $274.49
| Professional | | $132.09 | $148.58 | $274.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.47 / $179.29 / $241.35
| Professional | | $130.47 | $179.29 | $241.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.53 / $115.80 / $150.89
| Professional | | $90.53 | $115.80 | $150.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.21 / $174.68 / $186.87
| Professional | | $157.21 | $174.68 | $186.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.61 / $131.94 / $192.50
| Professional | | $102.61 | $131.94 | $192.50 |