- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.22 / $58.06 / $58.06
| Professional | | $53.22 | $58.06 | $58.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.55 / $103.55 / $103.55
| Professional | | $103.55 | $103.55 | $103.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.61 / $175.64 / $186.25
| Professional | | $153.61 | $175.64 | $186.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.05 / $69.63 / $90.08
| Professional | | $60.05 | $69.63 | $90.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.93 / $79.94 / $125.32
| Professional | | $56.93 | $79.94 | $125.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.67 / $55.67 / $69.06
| Professional | | $55.67 | $55.67 | $69.06 |