- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.84 / $82.12 / $113.87
| Professional | | $64.84 | $82.12 | $113.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.16 / $101.16 / $134.54
| Professional | | $101.16 | $101.16 | $134.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.50 / $108.12 / $254.98
| Professional | | $76.50 | $108.12 | $254.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.66 / $87.02 / $228.31
| Professional | | $70.66 | $87.02 | $228.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.50 / $119.20 / $289.87
| Professional | | $79.50 | $119.20 | $289.87 |