- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.40 / $77.15 / $143.88
| Professional | | $72.40 | $77.15 | $143.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.61 / $134.62 / $255.74
| Professional | | $38.61 | $134.62 | $255.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.46 / $92.13 / $110.88
| Professional | | $60.46 | $92.13 | $110.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.23 / $109.23 / $118.30
| Professional | | $109.23 | $109.23 | $118.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.40 / $82.22 / $143.88
| Professional | | $72.40 | $82.22 | $143.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.48 / $109.23 / $241.96
| Professional | | $56.48 | $109.23 | $241.96 |