- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.80 / $84.67 / $101.24
| Professional | | $76.80 | $84.67 | $101.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.50 / $90.78 / $103.16
| Professional | | $33.50 | $90.78 | $103.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.81 / $91.96 / $240.98
| Professional | | $62.81 | $91.96 | $240.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.33 / $103.33 / $103.33
| Professional | | $103.33 | $103.33 | $103.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.15 / $73.01 / $252.27
| Professional | | $34.15 | $73.01 | $252.27 |