- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.92 / $100.50 / $144.34
| Professional | | $89.92 | $100.50 | $144.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.93 / $109.88 / $156.02
| Professional | | $68.93 | $109.88 | $156.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.31 / $139.13 / $200.36
| Professional | | $111.31 | $139.13 | $200.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.66 / $138.94 / $232.44
| Professional | | $106.66 | $138.94 | $232.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.48 / $119.63 / $227.61
| Professional | | $94.48 | $119.63 | $227.61 |