- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.92 / $104.18 / $136.41
| Professional | | $74.92 | $104.18 | $136.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.62 / $107.78 / $154.51
| Professional | | $91.62 | $107.78 | $154.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.61 / $151.13 / $248.22
| Professional | | $100.61 | $151.13 | $248.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.58 / $149.63 / $265.58
| Professional | | $100.58 | $149.63 | $265.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.92 / $116.08 / $160.29
| Professional | | $83.92 | $116.08 | $160.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.02 / $152.35 / $240.35
| Professional | | $112.02 | $152.35 | $240.35 |