- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.52 / $130.76 / $182.11
| Professional | | $92.52 | $130.76 | $182.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.93 / $140.69 / $200.30
| Professional | | $104.93 | $140.69 | $200.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.03 / $205.18 / $488.73
| Professional | | $128.03 | $205.18 | $488.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.71 / $202.68 / $300.44
| Professional | | $150.71 | $202.68 | $300.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.52 / $130.76 / $182.11
| Professional | | $92.52 | $130.76 | $182.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.29 / $161.38 / $290.70
| Professional | | $117.29 | $161.38 | $290.70 |