- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $67.61 / $83.18
| Professional | | $45.71 | $67.61 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $77.62 / $151.36
| Professional | | $30.20 | $77.62 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $93.33 / $117.49
| Professional | | $89.13 | $93.33 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $69.18 / $147.91
| Professional | | $56.23 | $69.18 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $57.54 / $93.33
| Professional | | $22.91 | $57.54 | $93.33 |