- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.38 / $43.45 / $76.23
| Professional | | $34.38 | $43.45 | $76.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.56 / $73.59 / $143.68
| Professional | | $47.56 | $73.59 | $143.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.50 / $105.50 / $105.50
| Professional | | $105.50 | $105.50 | $105.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.67 / $67.39 / $81.43
| Professional | | $55.67 | $67.39 | $81.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.35 / $54.26 / $120.89
| Professional | | $45.35 | $54.26 | $120.89 |