- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.77 / $124.09 / $155.84
| Professional | | $119.77 | $124.09 | $155.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.17 / $138.35 / $203.10
| Professional | | $114.17 | $138.35 | $203.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.91 / $168.64 / $240.92
| Professional | | $131.91 | $168.64 | $240.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.25 / $181.72 / $285.62
| Professional | | $133.25 | $181.72 | $285.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.20 / $175.20 / $250.21
| Professional | | $115.20 | $175.20 | $250.21 |