- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.06 / $57.25 / $70.43
| Professional | | $42.06 | $57.25 | $70.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.42 / $121.40 / $159.85
| Professional | | $89.42 | $121.40 | $159.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.58 / $114.43 / $201.48
| Professional | | $67.58 | $114.43 | $201.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.68 / $119.57 / $328.40
| Professional | | $65.68 | $119.57 | $328.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.68 / $116.75 / $151.29
| Professional | | $65.68 | $116.75 | $151.29 |