- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.56 / $121.86 / $135.63
| Professional | | $102.56 | $121.86 | $135.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.22 / $146.22 / $185.70
| Professional | | $146.22 | $146.22 | $185.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.55 / $89.81 / $294.36
| Professional | | $57.55 | $89.81 | $294.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.30 / $174.36 / $240.44
| Professional | | $145.30 | $174.36 | $240.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.72 / $141.43 / $304.80
| Professional | | $95.72 | $141.43 | $304.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.38 / $179.57 / $209.58
| Professional | | $138.38 | $179.57 | $209.58 |