- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.67 / $118.40 / $163.66
| Professional | | $42.67 | $118.40 | $163.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.85 / $126.68 / $158.35
| Professional | | $110.85 | $126.68 | $158.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.92 / $136.66 / $311.07
| Professional | | $45.92 | $136.66 | $311.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.43 / $169.48 / $1,004.88
| Professional | | $107.43 | $169.48 | $1,004.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.32 / $160.56 / $252.20
| Professional | | $103.32 | $160.56 | $252.20 |