- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.53 / $134.77 / $210.09
| Professional | | $109.53 | $134.77 | $210.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.92 / $172.92 / $182.11
| Professional | | $172.92 | $172.92 | $182.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.52 / $194.61 / $318.23
| Professional | | $136.52 | $194.61 | $318.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.83 / $142.51 / $250.67
| Professional | | $105.83 | $142.51 | $250.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.30 / $201.92 / $285.06
| Professional | | $138.30 | $201.92 | $285.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.68 / $190.48 / $370.26
| Professional | | $125.68 | $190.48 | $370.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.62 / $151.66 / $151.66
| Professional | | $113.62 | $151.66 | $151.66 |