- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.30 / $60.74 / $272.85
| Professional | | $43.30 | $60.74 | $272.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.08 / $284.83 / $1,068.98
| Professional | | $96.08 | $284.83 | $1,068.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.66 / $202.25 / $242.41
| Professional | | $161.66 | $202.25 | $242.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.36 / $91.02 / $497.87
| Professional | | $69.36 | $91.02 | $497.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.15 / $49.72 / $194.50
| Professional | | $36.15 | $49.72 | $194.50 |