- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.85 / $112.77 / $130.07
| Professional | | $93.85 | $112.77 | $130.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.93 / $183.26 / $229.08
| Professional | | $164.93 | $183.26 | $229.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.51 / $109.51 / $207.17
| Professional | | $109.51 | $109.51 | $207.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.89 / $129.32 / $148.71
| Professional | | $100.89 | $129.32 | $148.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.15 / $101.35 / $144.16
| Professional | | $82.15 | $101.35 | $144.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.46 / $144.11 / $202.72
| Professional | | $124.46 | $144.11 | $202.72 |