- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.53 / $128.08 / $211.20
| Professional | | $37.53 | $128.08 | $211.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.55 / $127.06 / $200.99
| Professional | | $47.55 | $127.06 | $200.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.29 / $103.62 / $284.79
| Professional | | $39.29 | $103.62 | $284.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.32 / $178.80 / $1,196.56
| Professional | | $112.32 | $178.80 | $1,196.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.56 / $160.19 / $314.62
| Professional | | $106.56 | $160.19 | $314.62 |