- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.08 / $112.73 / $225.49
| Professional | | $81.08 | $112.73 | $225.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.07 / $169.04 / $244.16
| Professional | | $123.07 | $169.04 | $244.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.46 / $175.55 / $300.20
| Professional | | $123.46 | $175.55 | $300.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.75 / $185.02 / $333.76
| Professional | | $153.75 | $185.02 | $333.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.43 / $137.13 / $225.49
| Professional | | $100.43 | $137.13 | $225.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.17 / $156.51 / $302.57
| Professional | | $127.17 | $156.51 | $302.57 |