- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.03 / $72.95 / $102.59
| Professional | | $52.03 | $72.95 | $102.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.40 / $108.92 / $315.41
| Professional | | $92.40 | $108.92 | $315.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.86 / $117.55 / $190.23
| Professional | | $76.86 | $117.55 | $190.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.58 / $116.56 / $168.32
| Professional | | $87.58 | $116.56 | $168.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.65 / $119.48 / $347.33
| Professional | | $111.65 | $119.48 | $347.33 |