- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.31 / $86.41 / $110.98
| Professional | | $78.31 | $86.41 | $110.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.42 / $105.06 / $161.19
| Professional | | $84.42 | $105.06 | $161.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.63 / $109.97 / $206.12
| Professional | | $65.63 | $109.97 | $206.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.82 / $106.91 / $255.98
| Professional | | $62.82 | $106.91 | $255.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.48 / $115.86 / $181.72
| Professional | | $64.48 | $115.86 | $181.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.93 / $75.81 / $96.50
| Professional | | $68.93 | $75.81 | $96.50 |