- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.52 / $111.84 / $114.76
| Professional | | $94.52 | $111.84 | $114.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.44 / $19.35 / $57.66
| Professional | | $16.44 | $19.35 | $57.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.20 / $144.47 / $170.28
| Professional | | $103.20 | $144.47 | $170.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.02 / $116.96 / $550.35
| Professional | | $76.02 | $116.96 | $550.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $134.16
| Professional | | $32.34 | $32.34 | $134.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.28 / $100.55 / $174.74
| Professional | | $74.28 | $100.55 | $174.74 |