- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.79 / $105.50 / $113.98
| Professional | | $104.79 | $105.50 | $113.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.38 / $161.37 / $189.50
| Professional | | $132.38 | $161.37 | $189.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.10 / $141.36 / $223.64
| Professional | | $90.10 | $141.36 | $223.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.49 / $142.27 / $249.62
| Professional | | $91.49 | $142.27 | $249.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.94 / $150.16 / $268.95
| Professional | | $128.94 | $150.16 | $268.95 |