- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.38 / $76.51 / $142.13
| Professional | | $45.38 | $76.51 | $142.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.22 / $94.62 / $130.10
| Professional | | $54.22 | $94.62 | $130.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.31 / $105.80 / $197.16
| Professional | | $70.31 | $105.80 | $197.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.83 / $101.98 / $127.72
| Professional | | $74.83 | $101.98 | $127.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.52 / $133.19 / $239.91
| Professional | | $67.52 | $133.19 | $239.91 |