- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.92 / $121.85 / $222.48
| Professional | | $108.92 | $121.85 | $222.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.72 / $116.05 / $125.41
| Professional | | $111.72 | $116.05 | $125.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.90 / $153.88 / $257.75
| Professional | | $105.90 | $153.88 | $257.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.97 / $136.09 / $190.86
| Professional | | $111.97 | $136.09 | $190.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.97 / $155.41 / $265.25
| Professional | | $104.97 | $155.41 | $265.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.25 / $121.74 / $183.93
| Professional | | $103.25 | $121.74 | $183.93 |