- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.56 / $147.27 / $193.55
| Professional | | $110.56 | $147.27 | $193.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.50 / $141.66 / $177.09
| Professional | | $127.50 | $141.66 | $177.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.43 / $179.31 / $332.92
| Professional | | $119.43 | $179.31 | $332.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.14 / $133.41 / $217.48
| Professional | | $99.14 | $133.41 | $217.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.06 / $172.02 / $324.98
| Professional | | $127.06 | $172.02 | $324.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.05 / $212.63 / $236.25
| Professional | | $188.05 | $212.63 | $236.25 |