- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $151.36 / $346.74
| Professional | | $112.20 | $151.36 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $117.49 / $245.47
| Professional | | $95.50 | $117.49 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $141.25 / $234.42
| Professional | | $97.72 | $141.25 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $93.33 / $144.54
| Professional | | $63.10 | $93.33 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $36.31
| Professional | | $32.36 | $33.11 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $120.23 / $213.80
| Professional | | $85.11 | $120.23 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $109.65
| Professional | | $109.65 | $109.65 | $109.65 |