- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.14 / $77.11 / $99.25
| Professional | | $52.14 | $77.11 | $99.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.12 / $208.30 / $260.43
| Professional | | $121.12 | $208.30 | $260.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.63 / $185.71 / $303.11
| Professional | | $82.63 | $185.71 | $303.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.69 / $181.01 / $261.23
| Professional | | $105.69 | $181.01 | $261.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.44 / $95.49 / $244.25
| Professional | | $56.44 | $95.49 | $244.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.44 / $101.25 / $244.23
| Professional | | $56.44 | $101.25 | $244.23 |