- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.56 / $88.27 / $119.49
| Professional | | $77.56 | $88.27 | $119.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.42 / $134.16 / $207.80
| Professional | | $98.42 | $134.16 | $207.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.44 / $93.51 / $114.31
| Professional | | $71.44 | $93.51 | $114.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.10 / $148.50 / $196.12
| Professional | | $94.10 | $148.50 | $196.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.09 / $117.48 / $158.47
| Professional | | $80.09 | $117.48 | $158.47 |