- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.74 / $113.10 / $178.07
| Professional | | $88.74 | $113.10 | $178.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.26 / $132.85 / $252.96
| Professional | | $86.26 | $132.85 | $252.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.46 / $151.50 / $217.93
| Professional | | $120.46 | $151.50 | $217.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.67 / $126.41 / $210.96
| Professional | | $88.67 | $126.41 | $210.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.94 / $119.45 / $243.45
| Professional | | $90.94 | $119.45 | $243.45 |