- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.84 / $96.59 / $191.63
| Professional | | $81.84 | $96.59 | $191.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.68 / $135.84 / $169.16
| Professional | | $100.68 | $135.84 | $169.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.33 / $108.65 / $196.59
| Professional | | $55.33 | $108.65 | $196.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.52 / $141.68 / $154.65
| Professional | | $104.52 | $141.68 | $154.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.83 / $108.38 / $166.48
| Professional | | $85.83 | $108.38 | $166.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.76 / $98.20 / $191.35
| Professional | | $55.76 | $98.20 | $191.35 |