- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.67 / $111.90 / $136.63
| Professional | | $96.67 | $111.90 | $136.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.13 / $158.97 / $274.10
| Professional | | $135.13 | $158.97 | $274.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.28 / $165.85 / $165.85
| Professional | | $153.28 | $165.85 | $165.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.64 / $136.29 / $203.91
| Professional | | $106.64 | $136.29 | $203.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.44 / $135.93 / $168.92
| Professional | | $105.44 | $135.93 | $168.92 |