- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.02 / $106.61 / $185.57
| Professional | | $71.02 | $106.61 | $185.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.85 / $193.64 / $227.81
| Professional | | $102.85 | $193.64 | $227.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.78 / $128.38 / $209.10
| Professional | | $81.78 | $128.38 | $209.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.33 / $120.60 / $185.57
| Facility | | $84.33 | $120.60 | $185.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.95 / $147.18 / $224.96
| Professional | | $106.95 | $147.18 | $224.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.47 / $133.00 / $235.09
| Professional | | $105.47 | $133.00 | $235.09 |