- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.47 / $124.96 / $184.71
| Professional | | $90.47 | $124.96 | $184.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.65 / $141.32 / $198.39
| Professional | | $117.65 | $141.32 | $198.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.72 / $201.11 / $335.75
| Professional | | $128.72 | $201.11 | $335.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.43 / $187.14 / $291.19
| Professional | | $129.43 | $187.14 | $291.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.47 / $122.06 / $184.71
| Professional | | $90.47 | $122.06 | $184.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.30 / $214.15 / $309.51
| Professional | | $152.30 | $214.15 | $309.51 |