- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.64 / $112.75 / $129.04
| Professional | | $73.64 | $112.75 | $129.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.61 / $92.19 / $138.32
| Professional | | $74.61 | $92.19 | $138.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.58 / $160.65 / $203.91
| Professional | | $123.58 | $160.65 | $203.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.84 / $140.54 / $216.23
| Professional | | $102.84 | $140.54 | $216.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $89.06
| Professional | | $32.34 | $32.34 | $89.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.16 / $124.09 / $209.40
| Professional | | $96.16 | $124.09 | $209.40 |