- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.81 / $76.48 / $176.20
| Professional | | $50.81 | $76.48 | $176.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.61 / $48.33 / $144.57
| Professional | | $38.61 | $48.33 | $144.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.78 / $49.03 / $148.44
| Professional | | $45.78 | $49.03 | $148.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.56 / $112.62 / $156.51
| Professional | | $83.56 | $112.62 | $156.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.93 / $66.34 / $161.10
| Professional | | $59.93 | $66.34 | $161.10 |