- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $123.03 / $181.97
| Professional | | $93.33 | $123.03 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $218.78 / $323.59
| Professional | | $89.13 | $218.78 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $173.78 / $295.12
| Professional | | $114.82 | $173.78 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $147.91 / $229.09
| Professional | | $102.33 | $147.91 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $158.49 / $288.40
| Professional | | $104.71 | $158.49 | $288.40 |