- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.81 / $124.59 / $166.56
| Professional | | $101.81 | $124.59 | $166.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.20 / $201.18 / $271.58
| Professional | | $71.20 | $201.18 | $271.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.68 / $71.09 / $247.32
| Professional | | $47.68 | $71.09 | $247.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.65 / $92.58 / $221.13
| Professional | | $73.65 | $92.58 | $221.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.47 / $106.56 / $147.02
| Professional | | $34.47 | $106.56 | $147.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.49 / $81.64 / $176.88
| Professional | | $51.49 | $81.64 | $176.88 |