- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.66 / $78.89 / $116.43
| Professional | | $59.66 | $78.89 | $116.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.59 / $89.86 / $100.52
| Professional | | $81.59 | $89.86 | $100.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.41 / $85.97 / $145.44
| Professional | | $43.41 | $85.97 | $145.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.39 / $120.28 / $123.26
| Professional | | $117.39 | $120.28 | $123.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.35 / $48.08 / $73.09
| Professional | | $29.35 | $48.08 | $73.09 |