- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.50 / $117.74 / $146.22
| Professional | | $87.50 | $117.74 | $146.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.75 / $51.75 / $60.88
| Professional | | $51.75 | $51.75 | $60.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.89 / $124.89 / $140.03
| Professional | | $124.89 | $124.89 | $140.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $133.16
| Professional | | $32.34 | $32.34 | $133.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.20 / $129.19 / $137.01
| Professional | | $108.20 | $129.19 | $137.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.93 / $49.63 / $71.91
| Professional | | $40.93 | $49.63 | $71.91 |