- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.15 / $30.47 / $141.78
| Professional | | $30.15 | $30.47 | $141.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.01 / $165.41 / $272.86
| Professional | | $120.01 | $165.41 | $272.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.27 / $208.30 / $404.58
| Professional | | $126.27 | $208.30 | $404.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.38 / $262.38 / $424.02
| Professional | | $137.38 | $262.38 | $424.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.32 / $194.63 / $451.52
| Professional | | $138.32 | $194.63 | $451.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.43 / $113.77 / $144.80
| Professional | | $103.43 | $113.77 | $144.80 |