- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.60 / $137.72 / $155.46
| Professional | | $103.60 | $137.72 | $155.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.94 / $126.39 / $215.14
| Professional | | $88.94 | $126.39 | $215.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.79 / $191.75 / $520.82
| Professional | | $106.79 | $191.75 | $520.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.84 / $130.53 / $168.71
| Professional | | $108.84 | $130.53 | $168.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.01 / $77.78 / $119.03
| Professional | | $56.01 | $77.78 | $119.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.18 / $128.10 / $212.75
| Professional | | $100.18 | $128.10 | $212.75 |