- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.78 / $75.75 / $116.71
| Professional | | $52.78 | $75.75 | $116.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.15 / $105.85 / $135.13
| Professional | | $80.15 | $105.85 | $135.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.59 / $122.37 / $178.83
| Professional | | $80.59 | $122.37 | $178.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.03 / $109.65 / $194.62
| Professional | | $82.03 | $109.65 | $194.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.06 / $87.78 / $130.63
| Professional | | $58.06 | $87.78 | $130.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.28 / $114.12 / $176.01
| Professional | | $80.28 | $114.12 | $176.01 |