- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.01 / $85.19 / $126.75
| Professional | | $54.01 | $85.19 | $126.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.07 / $127.39 / $228.50
| Professional | | $108.07 | $127.39 | $228.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.81 / $81.89 / $131.63
| Professional | | $46.81 | $81.89 | $131.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.08 / $93.03 / $141.19
| Professional | | $54.08 | $93.03 | $141.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.37 / $113.39 / $143.25
| Professional | | $49.37 | $113.39 | $143.25 |