- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.56 / $121.25 / $175.79
| Professional | | $116.56 | $121.25 | $175.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.30 / $104.47 / $160.05
| Professional | | $79.30 | $104.47 | $160.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.50 / $147.55 / $187.28
| Professional | | $113.50 | $147.55 | $187.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.88 / $149.65 / $259.45
| Professional | | $107.88 | $149.65 | $259.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $76.31
| Professional | | $32.34 | $32.34 | $76.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.67 / $146.51 / $244.89
| Professional | | $105.67 | $146.51 | $244.89 |