- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.77 / $82.04 / $103.53
| Professional | | $72.77 | $82.04 | $103.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.20 / $102.20 / $102.20
| Professional | | $102.20 | $102.20 | $102.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.41 / $66.31 / $110.53
| Professional | | $46.41 | $66.31 | $110.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.76 / $102.93 / $163.52
| Professional | | $81.76 | $102.93 | $163.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.75 / $86.55 / $140.13
| Professional | | $52.75 | $86.55 | $140.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.64 / $32.34 / $74.94
| Professional | | $30.64 | $32.34 | $74.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.00 / $79.86 / $163.66
| Professional | | $48.00 | $79.86 | $163.66 |