- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.48 / $158.33 / $195.26
| Professional | | $114.48 | $158.33 | $195.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.81 / $181.67 / $324.13
| Professional | | $33.81 | $181.67 | $324.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.43 / $168.46 / $273.83
| Professional | | $104.43 | $168.46 | $273.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.36 / $164.42 / $238.61
| Professional | | $141.36 | $164.42 | $238.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.37 / $135.99 / $193.70
| Professional | | $109.37 | $135.99 | $193.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.46 / $181.86 / $252.71
| Professional | | $153.46 | $181.86 | $252.71 |