- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.19 / $54.93 / $65.38
| Professional | | $51.19 | $54.93 | $65.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.77 / $72.86 / $85.03
| Professional | | $63.77 | $72.86 | $85.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.70 / $67.47 / $97.60
| Professional | | $47.70 | $67.47 | $97.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.09 / $133.37 / $268.18
| Professional | | $127.09 | $133.37 | $268.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.95 / $74.65 / $101.63
| Professional | | $57.95 | $74.65 | $101.63 |