- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.71 / $61.47 / $82.26
| Professional | | $55.71 | $61.47 | $82.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.54 / $100.60 / $130.05
| Professional | | $70.54 | $100.60 | $130.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.72 / $99.38 / $190.63
| Professional | | $72.72 | $99.38 | $190.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.16 / $172.74 / $355.44
| Professional | | $115.16 | $172.74 | $355.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.56 / $94.72 / $144.54
| Professional | | $78.56 | $94.72 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.08 / $83.30 / $125.81
| Professional | | $70.08 | $83.30 | $125.81 |