- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.85 / $155.63 / $174.09
| Professional | | $87.85 | $155.63 | $174.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.79 / $172.97 / $235.26
| Professional | | $112.79 | $172.97 | $235.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.36 / $215.62 / $261.36
| Professional | | $146.36 | $215.62 | $261.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $218.05
| Professional | | $32.34 | $32.34 | $218.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.73 / $198.50 / $222.86
| Professional | | $168.73 | $198.50 | $222.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.84 / $156.31 / $200.97
| Professional | | $114.84 | $156.31 | $200.97 |