- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.32 / $102.06 / $148.19
| Professional | | $84.32 | $102.06 | $148.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.61 / $81.09 / $138.04
| Professional | | $61.61 | $81.09 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.76 / $135.46 / $217.71
| Professional | | $96.76 | $135.46 | $217.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.91 / $152.27 / $222.41
| Professional | | $107.91 | $152.27 | $222.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $35.47 / $120.48
| Professional | | $32.34 | $35.47 | $120.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.35 / $147.85 / $211.22
| Professional | | $99.35 | $147.85 | $211.22 |