- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.19 / $106.93 / $186.87
| Professional | | $80.19 | $106.93 | $186.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.50 / $143.47 / $189.26
| Professional | | $108.50 | $143.47 | $189.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.11 / $89.98 / $111.24
| Professional | | $70.11 | $89.98 | $111.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.95 / $145.43 / $197.73
| Professional | | $102.95 | $145.43 | $197.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.49 / $127.04 / $198.19
| Professional | | $104.49 | $127.04 | $198.19 |