- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.02 / $69.41 / $85.17
| Professional | | $55.02 | $69.41 | $85.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.93 / $88.96 / $156.60
| Professional | | $58.93 | $88.96 | $156.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.26 / $123.54 / $175.18
| Professional | | $101.26 | $123.54 | $175.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.37 / $65.36 / $117.45
| Professional | | $51.37 | $65.36 | $117.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.75 / $74.43 / $129.62
| Professional | | $43.75 | $74.43 | $129.62 |