- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.71 / $127.88 / $165.45
| Professional | | $100.71 | $127.88 | $165.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.39 / $107.52 / $160.71
| Professional | | $87.39 | $107.52 | $160.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.55 / $196.29 / $273.10
| Professional | | $136.55 | $196.29 | $273.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $188.57
| Professional | | $32.34 | $32.34 | $188.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.03 / $196.29 / $264.56
| Professional | | $139.03 | $196.29 | $264.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.09 / $197.64 / $277.29
| Professional | | $132.09 | $197.64 | $277.29 |