- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.21 / $144.25 / $272.06
| Professional | | $106.21 | $144.25 | $272.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.22 / $169.32 / $255.52
| Professional | | $126.22 | $169.32 | $255.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.57 / $143.46 / $260.33
| Professional | | $97.57 | $143.46 | $260.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.00 / $146.91 / $255.74
| Professional | | $72.00 | $146.91 | $255.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.34 / $108.46 / $158.91
| Professional | | $100.34 | $108.46 | $158.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.91 / $173.20 / $273.25
| Professional | | $133.91 | $173.20 | $273.25 |