- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.84 / $78.06 / $101.20
| Professional | | $66.84 | $78.06 | $101.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.48 / $120.29 / $152.56
| Professional | | $77.48 | $120.29 | $152.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.25 / $96.31 / $122.18
| Professional | | $91.25 | $96.31 | $122.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.78 / $53.78 / $76.12
| Professional | | $53.78 | $53.78 | $76.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.50 / $120.94 / $144.57
| Professional | | $84.50 | $120.94 | $144.57 |