- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.37 / $173.70 / $176.18
| Professional | | $161.37 | $173.70 | $176.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.27 / $192.27 / $217.27
| Professional | | $192.27 | $192.27 | $217.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.06 / $174.73 / $319.75
| Professional | | $140.06 | $174.73 | $319.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.15 / $208.19 / $378.52
| Professional | | $173.15 | $208.19 | $378.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.22 / $169.78 / $335.45
| Professional | | $132.22 | $169.78 | $335.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.46 / $189.26 / $199.12
| Professional | | $127.46 | $189.26 | $199.12 |