- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $46.77 / $56.23
| Professional | | $32.36 | $46.77 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $131.83 / $147.91
| Professional | | $97.72 | $131.83 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $109.65 / $199.53
| Professional | | $41.69 | $109.65 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $45.71 / $295.12
| Professional | | $28.18 | $45.71 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $57.54 / $107.15
| Professional | | $31.62 | $57.54 | $107.15 |