- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.16 / $110.64 / $137.35
| Professional | | $109.16 | $110.64 | $137.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.77 / $147.52 / $180.52
| Professional | | $132.77 | $147.52 | $180.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.92 / $113.42 / $362.97
| Professional | | $80.92 | $113.42 | $362.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.52 / $177.02 / $221.28
| Professional | | $147.52 | $177.02 | $221.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.51 / $134.94 / $245.84
| Professional | | $88.51 | $134.94 | $245.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.76 / $73.76 / $144.79
| Professional | | $73.76 | $73.76 | $144.79 |