- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.61 / $116.75 / $204.73
| Professional | | $95.61 | $116.75 | $204.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.73 / $145.93 / $171.68
| Professional | | $97.73 | $145.93 | $171.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.51 / $295.89 / $312.55
| Professional | | $92.51 | $295.89 | $312.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.99 / $102.69 / $131.44
| Professional | | $82.99 | $102.69 | $131.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.62 / $146.43 / $294.08
| Professional | | $99.62 | $146.43 | $294.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.47 / $120.21 / $430.41
| Professional | | $92.47 | $120.21 | $430.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.81 / $153.43 / $241.70
| Professional | | $85.81 | $153.43 | $241.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.06 / $132.31 / $252.66
| Professional | | $99.06 | $132.31 | $252.66 |