- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.06 / $115.70 / $216.26
| Professional | | $81.06 | $115.70 | $216.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.56 / $127.59 / $197.37
| Professional | | $65.56 | $127.59 | $197.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.68 / $138.65 / $212.61
| Professional | | $95.68 | $138.65 | $212.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $178.81
| Professional | | $32.34 | $32.34 | $178.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.50 / $153.55 / $240.22
| Professional | | $98.50 | $153.55 | $240.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.13 / $180.18 / $268.20
| Professional | | $128.13 | $180.18 | $268.20 |