- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.43 / $108.85 / $141.51
| Professional | | $100.43 | $108.85 | $141.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.68 / $101.68 / $130.15
| Professional | | $84.68 | $101.68 | $130.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.98 / $148.28 / $294.64
| Professional | | $90.98 | $148.28 | $294.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.72 / $118.36 / $161.43
| Professional | | $80.72 | $118.36 | $161.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.79 / $114.04 / $212.16
| Professional | | $82.79 | $114.04 | $212.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.06 / $123.76 / $155.54
| Professional | | $114.06 | $123.76 | $155.54 |