- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.81 / $123.43 / $157.11
| Professional | | $98.81 | $123.43 | $157.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.17 / $104.90 / $175.84
| Professional | | $27.17 | $104.90 | $175.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.44 / $133.94 / $277.24
| Professional | | $97.44 | $133.94 | $277.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.43 / $120.51 / $164.83
| Professional | | $105.43 | $120.51 | $164.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.26 / $101.62 / $146.34
| Professional | | $82.26 | $101.62 | $146.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.32 / $132.66 / $181.89
| Professional | | $107.32 | $132.66 | $181.89 |