- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.16 / $129.66 / $162.52
| Professional | | $100.16 | $129.66 | $162.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.05 / $159.26 / $282.45
| Professional | | $105.05 | $159.26 | $282.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.28 / $85.54 / $121.01
| Professional | | $44.28 | $85.54 | $121.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.45 / $81.78 / $134.56
| Professional | | $52.45 | $81.78 | $134.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.66 / $125.62 / $233.33
| Professional | | $87.66 | $125.62 | $233.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.39 / $99.39 / $99.39
| Professional | | $99.39 | $99.39 | $99.39 |