- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.37 / $70.56 / $96.81
| Professional | | $48.37 | $70.56 | $96.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.20 / $85.51 / $158.90
| Professional | | $46.20 | $85.51 | $158.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.52 / $109.47 / $139.12
| Professional | | $105.52 | $109.47 | $139.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.57 / $70.08 / $98.27
| Professional | | $59.57 | $70.08 | $98.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.69 / $65.06 / $124.57
| Professional | | $26.69 | $65.06 | $124.57 |