- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.56 / $90.62 / $116.57
| Professional | | $77.56 | $90.62 | $116.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.10 / $219.81 / $288.58
| Professional | | $121.10 | $219.81 | $288.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.69 / $227.29 / $353.93
| Professional | | $148.69 | $227.29 | $353.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.33 / $211.56 / $319.80
| Professional | | $139.33 | $211.56 | $319.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.00 / $194.37 / $534.04
| Professional | | $106.00 | $194.37 | $534.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.36 / $196.60 / $343.67
| Professional | | $104.36 | $196.60 | $343.67 |