- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.42 / $128.87 / $180.39
| Professional | | $97.42 | $128.87 | $180.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.59 / $88.10 / $159.19
| Professional | | $68.59 | $88.10 | $159.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.40 / $145.47 / $218.28
| Professional | | $101.40 | $145.47 | $218.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.55 / $175.82 / $282.32
| Professional | | $121.55 | $175.82 | $282.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $50.62 / $155.91
| Professional | | $32.34 | $50.62 | $155.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.78 / $185.02 / $289.08
| Professional | | $132.78 | $185.02 | $289.08 |