- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.21 / $42.11 / $64.62
| Professional | | $33.21 | $42.11 | $64.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.10 / $100.31 / $158.02
| Professional | | $85.10 | $100.31 | $158.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.41 / $58.75 / $102.65
| Professional | | $44.41 | $58.75 | $102.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.12 / $72.25 / $102.65
| Professional | | $45.12 | $72.25 | $102.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.13 / $72.11 / $184.57
| Professional | | $60.13 | $72.11 | $184.57 |