- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.31 / $128.77 / $167.83
| Professional | | $96.31 | $128.77 | $167.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.75 / $131.75 / $131.75
| Professional | | $131.75 | $131.75 | $131.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.78 / $140.84 / $201.28
| Professional | | $90.78 | $140.84 | $201.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.53 / $156.63 / $234.96
| Professional | | $130.53 | $156.63 | $234.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.96 / $151.47 / $239.90
| Professional | | $110.96 | $151.47 | $239.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.79 / $152.25 / $283.60
| Professional | | $112.79 | $152.25 | $283.60 |