- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.38 / $112.76 / $189.71
| Professional | | $97.38 | $112.76 | $189.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.28 / $168.16 / $273.93
| Professional | | $110.28 | $168.16 | $273.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.61 / $119.71 / $210.56
| Professional | | $96.61 | $119.71 | $210.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.46 / $164.71 / $236.65
| Professional | | $111.46 | $164.71 | $236.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.91 / $165.69 / $297.85
| Professional | | $114.91 | $165.69 | $297.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.81 / $126.64 / $126.64
| Professional | | $86.81 | $126.64 | $126.64 |