- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.68 / $136.44 / $212.70
| Professional | | $90.68 | $136.44 | $212.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.10 / $174.58 / $308.62
| Professional | | $110.10 | $174.58 | $308.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.69 / $252.65 / $512.53
| Professional | | $128.69 | $252.65 | $512.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.43 / $232.92 / $541.57
| Professional | | $109.43 | $232.92 | $541.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.79 / $272.43 / $485.09
| Professional | | $187.79 | $272.43 | $485.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.08 / $124.66 / $193.04
| Professional | | $79.08 | $124.66 | $193.04 |