- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.66 / $127.25 / $162.52
| Professional | | $104.66 | $127.25 | $162.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.89 / $111.60 / $169.85
| Professional | | $83.89 | $111.60 | $169.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.22 / $74.51 / $133.19
| Professional | | $53.22 | $74.51 | $133.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.79 / $139.72 / $223.76
| Professional | | $102.79 | $139.72 | $223.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.65 / $32.34 / $60.15
| Professional | | $11.65 | $32.34 | $60.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.37 / $130.33 / $253.13
| Professional | | $83.37 | $130.33 | $253.13 |