- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.58 / $125.74 / $156.27
| Professional | | $119.58 | $125.74 | $156.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.83 / $235.65 / $416.58
| Professional | | $114.83 | $235.65 | $416.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.38 / $213.08 / $349.34
| Professional | | $150.38 | $213.08 | $349.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.46 / $207.61 / $433.04
| Professional | | $131.46 | $207.61 | $433.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.68 / $212.60 / $476.40
| Professional | | $145.68 | $212.60 | $476.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.90 / $129.88 / $199.24
| Professional | | $101.90 | $129.88 | $199.24 |