- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.10 / $134.33 / $197.45
| Professional | | $98.10 | $134.33 | $197.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.18 / $142.51 / $203.47
| Professional | | $113.18 | $142.51 | $203.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.74 / $197.58 / $288.73
| Professional | | $131.74 | $197.58 | $288.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.32 / $180.54 / $320.44
| Professional | | $132.32 | $180.54 | $320.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.74 / $138.11 / $272.14
| Professional | | $104.74 | $138.11 | $272.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.07 / $194.56 / $289.07
| Professional | | $135.07 | $194.56 | $289.07 |