- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.38 / $105.09 / $143.07
| Professional | | $94.38 | $105.09 | $143.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.59 / $133.13 / $191.22
| Professional | | $103.59 | $133.13 | $191.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.61 / $90.12 / $106.03
| Professional | | $71.61 | $90.12 | $106.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.22 / $141.68 / $180.24
| Professional | | $117.22 | $141.68 | $180.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.90 / $111.60 / $165.41
| Professional | | $89.90 | $111.60 | $165.41 |