- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.43 / $133.96 / $216.89
| Professional | | $112.43 | $133.96 | $216.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.15 / $101.15 / $101.15
| Professional | | $101.15 | $101.15 | $101.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.56 / $137.77 / $226.13
| Professional | | $104.56 | $137.77 | $226.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.04 / $131.35 / $166.72
| Professional | | $101.04 | $131.35 | $166.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.24 / $164.69 / $254.70
| Professional | | $114.24 | $164.69 | $254.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $131.35
| Professional | | $32.34 | $32.34 | $131.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.77 / $138.82 / $186.33
| Professional | | $114.77 | $138.82 | $186.33 |