- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.28 / $71.77 / $140.21
| Professional | | $45.28 | $71.77 | $140.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.50 / $91.52 / $126.46
| Professional | | $51.50 | $91.52 | $126.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.65 / $116.54 / $187.78
| Professional | | $71.65 | $116.54 | $187.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.14 / $111.55 / $139.69
| Professional | | $70.14 | $111.55 | $139.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.34 / $133.29 / $236.45
| Professional | | $68.34 | $133.29 | $236.45 |