- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.52 / $119.14 / $186.56
| Professional | | $88.52 | $119.14 | $186.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.14 / $80.14 / $112.75
| Professional | | $80.14 | $80.14 | $112.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.74 / $154.84 / $277.33
| Professional | | $115.74 | $154.84 | $277.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.01 / $147.08 / $314.00
| Professional | | $100.01 | $147.08 | $314.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.68 / $141.13 / $226.84
| Professional | | $109.68 | $141.13 | $226.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.70 / $127.89 / $194.61
| Professional | | $87.70 | $127.89 | $194.61 |