- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.89 / $109.91 / $130.38
| Professional | | $100.89 | $109.91 | $130.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.74 / $114.74 / $156.91
| Professional | | $114.74 | $114.74 | $156.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.51 / $109.51 / $134.76
| Professional | | $109.51 | $109.51 | $134.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.44 / $126.44 / $126.44
| Professional | | $126.44 | $126.44 | $126.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.83 / $104.96 / $128.32
| Professional | | $80.83 | $104.96 | $128.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.77 / $136.61 / $196.52
| Professional | | $111.77 | $136.61 | $196.52 |