- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.31 / $111.54 / $143.82
| Professional | | $98.31 | $111.54 | $143.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.13 / $168.72 / $231.73
| Professional | | $105.13 | $168.72 | $231.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.33 / $214.92 / $330.52
| Professional | | $143.33 | $214.92 | $330.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.59 / $207.79 / $396.44
| Professional | | $128.59 | $207.79 | $396.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.65 / $189.38 / $347.75
| Professional | | $133.65 | $189.38 | $347.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.25 / $102.11 / $138.63
| Professional | | $80.25 | $102.11 | $138.63 |