- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.54 / $42.28 / $42.28
| Professional | | $35.54 | $42.28 | $42.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.56 / $92.06 / $100.92
| Professional | | $76.56 | $92.06 | $100.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.98 / $57.07 / $70.63
| Professional | | $53.98 | $57.07 | $70.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.37 / $57.17 / $233.75
| Professional | | $30.37 | $57.17 | $233.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.37 / $47.14 / $72.44
| Professional | | $30.37 | $47.14 | $72.44 |