- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.78 / $76.34 / $136.59
| Professional | | $47.78 | $76.34 | $136.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.08 / $68.15 / $101.16
| Professional | | $61.08 | $68.15 | $101.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.36 / $174.46 / $205.86
| Professional | | $127.36 | $174.46 | $205.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.09 / $84.89 / $240.18
| Professional | | $68.09 | $84.89 | $240.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.62 / $81.20 / $106.56
| Professional | | $56.62 | $81.20 | $106.56 |