- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $102.33 / $162.18
| Professional | | $72.44 | $102.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $128.82 / $223.87
| Professional | | $77.62 | $128.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $107.15 / $141.25
| Professional | | $63.10 | $107.15 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $63.10 / $165.96
| Professional | | $32.36 | $63.10 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $102.33 / $186.21
| Professional | | $69.18 | $102.33 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $97.72 / $141.25
| Professional | | $67.61 | $97.72 | $141.25 |