- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.76 / $121.93 / $161.47
| Professional | | $105.76 | $121.93 | $161.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.18 / $158.12 / $247.53
| Professional | | $122.18 | $158.12 | $247.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.97 / $209.66 / $332.67
| Professional | | $106.97 | $209.66 | $332.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.20 / $191.09 / $247.45
| Professional | | $189.20 | $191.09 | $247.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.76 / $125.62 / $205.51
| Professional | | $105.76 | $125.62 | $205.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.69 / $189.78 / $245.40
| Professional | | $140.69 | $189.78 | $245.40 |