- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.33 / $120.70 / $148.76
| Professional | | $116.33 | $120.70 | $148.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.42 / $132.60 / $214.42
| Professional | | $109.42 | $132.60 | $214.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.36 / $24.98 / $199.64
| Professional | | $14.36 | $24.98 | $199.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.45 / $171.90 / $270.06
| Professional | | $117.45 | $171.90 | $270.06 |
- 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
- $116.27 / $167.36 / $252.85
| Professional | | $116.27 | $167.36 | $252.85 |