- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.16 / $110.44 / $145.37
| Professional | | $79.16 | $110.44 | $145.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.31 / $136.86 / $192.53
| Professional | | $106.31 | $136.86 | $192.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.32 / $172.69 / $252.36
| Professional | | $108.32 | $172.69 | $252.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.94 / $156.22 / $277.27
| Professional | | $112.94 | $156.22 | $277.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $110.44 / $144.79
| Professional | | $83.18 | $110.44 | $144.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.46 / $144.80 / $274.95
| Professional | | $98.46 | $144.80 | $274.95 |