- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.47 / $53.61 / $70.16
| Professional | | $35.47 | $53.61 | $70.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.33 / $102.83 / $147.13
| Professional | | $59.33 | $102.83 | $147.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.57 / $64.47 / $126.49
| Professional | | $45.57 | $64.47 | $126.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.12 / $67.12 / $105.50
| Professional | | $67.12 | $67.12 | $105.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.50 / $82.62 / $174.88
| Professional | | $40.50 | $82.62 | $174.88 |