- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.56 / $104.51 / $128.59
| Professional | | $96.56 | $104.51 | $128.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.31 / $127.42 / $202.08
| Professional | | $108.31 | $127.42 | $202.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.51 / $109.51 / $109.51
| Professional | | $109.51 | $109.51 | $109.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.62 / $184.62 / $184.62
| Professional | | $184.62 | $184.62 | $184.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.91 / $104.94 / $130.07
| Professional | | $95.91 | $104.94 | $130.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.51 / $109.51 / $109.51
| Professional | | $109.51 | $109.51 | $109.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.71 / $120.93 / $141.59
| Professional | | $117.71 | $120.93 | $141.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.57 / $154.37 / $243.12
| Professional | | $112.57 | $154.37 | $243.12 |