- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.41 / $98.77 / $700.95
| Professional | | $72.41 | $98.77 | $700.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.34 / $101.27 / $129.76
| Professional | | $68.34 | $101.27 | $129.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.14 / $107.88 / $117.74
| Professional | | $97.14 | $107.88 | $117.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $83.16 / $104.62
| Professional | | $32.34 | $83.16 | $104.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.77 / $95.02 / $109.23
| Professional | | $80.77 | $95.02 | $109.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.75 / $95.05 / $128.63
| Professional | | $72.75 | $95.05 | $128.63 |