- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.04 / $100.60 / $150.32
| Professional | | $77.04 | $100.60 | $150.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.77 / $147.77 / $147.77
| Professional | | $147.77 | $147.77 | $147.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.43 / $115.69 / $204.38
| Professional | | $76.43 | $115.69 | $204.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.64 / $99.51 / $140.63
| Professional | | $42.64 | $99.51 | $140.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.81 / $146.20 / $224.39
| Professional | | $109.81 | $146.20 | $224.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.00 / $110.78 / $161.50
| Professional | | $86.00 | $110.78 | $161.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.64 / $75.64 / $102.14
| Professional | | $75.64 | $75.64 | $102.14 |