- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.10 / $43.25 / $57.14
| Professional | | $32.10 | $43.25 | $57.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.84 / $69.37 / $180.24
| Professional | | $58.84 | $69.37 | $180.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.41 / $61.68 / $109.36
| Professional | | $41.41 | $61.68 | $109.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.52 / $65.88 / $109.36
| Professional | | $43.52 | $65.88 | $109.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.05 / $68.95 / $199.67
| Professional | | $65.05 | $68.95 | $199.67 |