- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.06 / $118.29 / $225.37
| Professional | | $81.06 | $118.29 | $225.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.51 / $132.46 / $214.60
| Professional | | $22.51 | $132.46 | $214.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.62 / $122.60 / $224.65
| Professional | | $84.62 | $122.60 | $224.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.90 / $135.86 / $225.37
| Professional | | $114.90 | $135.86 | $225.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.79 / $101.78 / $144.21
| Professional | | $81.79 | $101.78 | $144.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.22 / $143.29 / $197.67
| Professional | | $120.22 | $143.29 | $197.67 |