- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.20 / $111.22 / $194.50
| Professional | | $96.20 | $111.22 | $194.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.04 / $123.46 / $163.53
| Professional | | $57.04 | $123.46 | $163.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.87 / $155.11 / $196.40
| Professional | | $104.87 | $155.11 | $196.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $168.02
| Professional | | $32.34 | $32.34 | $168.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.54 / $164.89 / $264.48
| Professional | | $111.54 | $164.89 | $264.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.10 / $170.03 / $249.29
| Professional | | $119.10 | $170.03 | $249.29 |