- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.97 / $131.79 / $146.55
| Professional | | $91.97 | $131.79 | $146.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.02 / $137.91 / $163.51
| Professional | | $65.02 | $137.91 | $163.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.04 / $170.53 / $192.78
| Professional | | $159.04 | $170.53 | $192.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $152.66
| Professional | | $32.34 | $32.34 | $152.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.71 / $150.74 / $170.53
| Professional | | $142.71 | $150.74 | $170.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.48 / $122.40 / $165.20
| Professional | | $92.48 | $122.40 | $165.20 |