- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.45 / $116.12 / $201.45
| Professional | | $73.45 | $116.12 | $201.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.72 / $68.45 / $152.41
| Professional | | $29.72 | $68.45 | $152.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.51 / $172.92 / $341.45
| Professional | | $75.51 | $172.92 | $341.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.53 / $114.74 / $119.15
| Professional | | $97.53 | $114.74 | $119.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.27 / $140.36 / $289.06
| Professional | | $105.27 | $140.36 | $289.06 |