- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.96 / $191.13 / $280.58
| Professional | | $115.96 | $191.13 | $280.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.52 / $143.97 / $186.89
| Professional | | $131.52 | $143.97 | $186.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.69 / $205.01 / $455.03
| Professional | | $107.69 | $205.01 | $455.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.34 / $243.19 / $314.17
| Professional | | $135.34 | $243.19 | $314.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.01 / $167.51 / $235.52
| Professional | | $136.01 | $167.51 | $235.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.78 / $261.82 / $340.50
| Professional | | $202.78 | $261.82 | $340.50 |