- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.64 / $121.40 / $175.74
| Professional | | $106.64 | $121.40 | $175.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.45 / $169.85 / $274.98
| Professional | | $116.45 | $169.85 | $274.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.74 / $198.85 / $410.72
| Professional | | $129.74 | $198.85 | $410.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.31 / $219.30 / $411.46
| Professional | | $133.31 | $219.30 | $411.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.11 / $182.47 / $397.80
| Professional | | $123.11 | $182.47 | $397.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.59 / $117.25 / $149.22
| Professional | | $106.59 | $117.25 | $149.22 |