- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.90 / $61.28 / $111.47
| Professional | | $48.90 | $61.28 | $111.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.52 / $137.69 / $150.96
| Professional | | $114.52 | $137.69 | $150.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.09 / $116.20 / $200.25
| Professional | | $43.09 | $116.20 | $200.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.18 / $86.36 / $322.74
| Professional | | $43.18 | $86.36 | $322.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.18 / $67.00 / $101.60
| Professional | | $43.18 | $67.00 | $101.60 |