- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.03 / $77.47 / $135.77
| Professional | | $61.03 | $77.47 | $135.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.54 / $59.93 / $103.11
| Professional | | $43.54 | $59.93 | $103.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.97 / $82.54 / $234.88
| Professional | | $32.97 | $82.54 | $234.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.60 / $493.60 / $759.30
| Professional | | $493.60 | $493.60 | $759.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.07 / $66.73 / $101.09
| Professional | | $37.07 | $66.73 | $101.09 |