- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.66 / $136.07 / $188.32
| Professional | | $104.66 | $136.07 | $188.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.13 / $216.03 / $260.51
| Professional | | $155.13 | $216.03 | $260.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.14 / $203.79 / $237.58
| Professional | | $192.14 | $203.79 | $237.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $93.12 / $189.49
| Professional | | $32.34 | $93.12 | $189.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.78 / $182.09 / $237.58
| Professional | | $154.78 | $182.09 | $237.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.00 / $180.39 / $257.04
| Professional | | $133.00 | $180.39 | $257.04 |