- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.01 / $57.70 / $238.44
| Professional | | $38.01 | $57.70 | $238.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.77 / $274.63 / $1,030.14
| Professional | | $92.77 | $274.63 | $1,030.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.47 / $202.25 / $242.41
| Professional | | $160.47 | $202.25 | $242.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.36 / $91.02 / $474.53
| Professional | | $69.36 | $91.02 | $474.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.15 / $49.72 / $201.02
| Professional | | $36.15 | $49.72 | $201.02 |