- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.72 / $138.69 / $248.56
| Professional | | $137.72 | $138.69 | $248.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.37 / $125.37 / $125.37
| Professional | | $125.37 | $125.37 | $125.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.00 / $53.64 / $140.77
| Professional | | $31.00 | $53.64 | $140.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.06 / $133.47 / $217.47
| Professional | | $89.06 | $133.47 | $217.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.83 / $128.99 / $174.79
| Professional | | $101.83 | $128.99 | $174.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.28 / $123.30 / $184.39
| Professional | | $98.28 | $123.30 | $184.39 |