- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.88 / $51.68 / $67.22
| Professional | | $43.88 | $51.68 | $67.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.30 / $42.25 / $71.72
| Professional | | $31.30 | $42.25 | $71.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.79 / $55.72 / $155.16
| Professional | | $32.79 | $55.72 | $155.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.74 / $322.74 / $504.68
| Professional | | $322.74 | $322.74 | $504.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.16 / $43.89 / $72.68
| Professional | | $31.16 | $43.89 | $72.68 |