- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.54 / $100.06 / $127.90
| Professional | | $89.54 | $100.06 | $127.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.57 / $104.70 / $163.71
| Professional | | $87.57 | $104.70 | $163.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.69 / $116.32 / $167.14
| Professional | | $81.69 | $116.32 | $167.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.10 / $122.61 / $189.09
| Professional | | $90.10 | $122.61 | $189.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $108.64
| Professional | | $32.34 | $32.34 | $108.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.73 / $106.47 / $149.56
| Professional | | $83.73 | $106.47 | $149.56 |