- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.64 / $59.85 / $86.19
| Professional | | $40.64 | $59.85 | $86.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.16 / $131.22 / $131.22
| Professional | | $128.16 | $131.22 | $131.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.24 / $47.24 / $47.24
| Professional | | $47.24 | $47.24 | $47.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.02 / $107.02 / $107.02
| Professional | | $107.02 | $107.02 | $107.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.73 / $65.47 / $78.92
| Professional | | $45.73 | $65.47 | $78.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.83 / $97.71 / $124.36
| Professional | | $88.83 | $97.71 | $124.36 |