- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.91 / $133.34 / $192.56
| Professional | | $99.91 | $133.34 | $192.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.30 / $101.53 / $176.36
| Professional | | $67.30 | $101.53 | $176.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.75 / $139.37 / $220.68
| Professional | | $107.75 | $139.37 | $220.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.26 / $154.66 / $244.84
| Professional | | $107.26 | $154.66 | $244.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.72 / $158.91 / $265.38
| Professional | | $114.72 | $158.91 | $265.38 |