- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.84 / $97.08 / $132.13
| Professional | | $89.84 | $97.08 | $132.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.53 / $103.03 / $219.10
| Professional | | $78.53 | $103.03 | $219.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.94 / $189.57 / $236.17
| Professional | | $114.94 | $189.57 | $236.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $164.27
| Professional | | $32.34 | $32.34 | $164.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.31 / $191.15 / $294.70
| Professional | | $114.31 | $191.15 | $294.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.79 / $156.60 / $230.67
| Professional | | $126.79 | $156.60 | $230.67 |