- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.15 / $45.50 / $54.72
| Professional | | $30.15 | $45.50 | $54.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.04 / $89.35 / $139.37
| Professional | | $69.04 | $89.35 | $139.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.96 / $104.66 / $148.40
| Professional | | $51.96 | $104.66 | $148.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.42 / $95.58 / $256.32
| Professional | | $53.42 | $95.58 | $256.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.41 / $94.54 / $117.50
| Professional | | $53.41 | $94.54 | $117.50 |