- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.03 / $105.48 / $235.17
| Professional | | $59.03 | $105.48 | $235.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.54 / $137.12 / $218.44
| Professional | | $79.54 | $137.12 | $218.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.84 / $146.44 / $306.63
| Professional | | $78.84 | $146.44 | $306.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.91 / $150.71 / $298.42
| Professional | | $84.91 | $150.71 | $298.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.22 / $105.48 / $207.00
| Professional | | $63.22 | $105.48 | $207.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.10 / $203.42 / $296.68
| Professional | | $125.10 | $203.42 | $296.68 |