- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.94 / $135.16 / $178.09
| Professional | | $104.94 | $135.16 | $178.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.17 / $227.28 / $304.02
| Professional | | $57.17 | $227.28 | $304.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.16 / $140.31 / $506.85
| Professional | | $70.16 | $140.31 | $506.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.75 / $214.10 / $486.90
| Professional | | $157.75 | $214.10 | $486.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.95 / $140.31 / $190.45
| Professional | | $93.95 | $140.31 | $190.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.82 / $125.93 / $176.01
| Professional | | $107.82 | $125.93 | $176.01 |