- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.31 / $66.53 / $106.41
| Professional | | $54.31 | $66.53 | $106.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.19 / $100.04 / $145.03
| Professional | | $53.19 | $100.04 | $145.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.77 / $86.85 / $108.91
| Professional | | $68.77 | $86.85 | $108.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.76 / $110.50 / $122.14
| Professional | | $96.76 | $110.50 | $122.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.08 / $67.23 / $108.97
| Professional | | $38.08 | $67.23 | $108.97 |