- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.64 / $167.47 / $264.68
| Professional | | $105.64 | $167.47 | $264.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.78 / $159.54 / $241.50
| Professional | | $90.78 | $159.54 | $241.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.80 / $147.91 / $281.01
| Professional | | $112.80 | $147.91 | $281.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.05 / $206.63 / $369.09
| Professional | | $112.05 | $206.63 | $369.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $211.83
| Professional | | $32.34 | $32.34 | $211.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.18 / $248.27 / $399.73
| Professional | | $174.18 | $248.27 | $399.73 |