- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.85 / $103.77 / $104.02
| Professional | | $91.85 | $103.77 | $104.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.40 / $102.67 / $118.07
| Professional | | $92.40 | $102.67 | $118.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.47 / $108.19 / $184.30
| Professional | | $76.47 | $108.19 | $184.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.81 / $120.62 / $229.76
| Professional | | $102.81 | $120.62 | $229.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.51 / $98.72 / $182.67
| Professional | | $64.51 | $98.72 | $182.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.88 / $114.88 / $119.67
| Professional | | $114.88 | $114.88 | $119.67 |