- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.33 / $45.72 / $79.41
| Professional | | $30.33 | $45.72 | $79.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.77 / $57.19 / $92.77
| Professional | | $35.77 | $57.19 | $92.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.63 / $58.42 / $100.57
| Professional | | $38.63 | $58.42 | $100.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.56 / $405.28 / $474.08
| Professional | | $252.56 | $405.28 | $474.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.40 / $57.15 / $105.21
| Professional | | $45.40 | $57.15 | $105.21 |