- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.02 / $69.39 / $108.86
| Professional | | $45.02 | $69.39 | $108.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.50 / $59.86 / $103.68
| Professional | | $48.50 | $59.86 | $103.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.70 / $85.46 / $151.22
| Professional | | $54.70 | $85.46 | $151.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.42 / $116.32 / $1,687.42
| Professional | | $69.42 | $116.32 | $1,687.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.88 / $95.11 / $167.05
| Professional | | $66.88 | $95.11 | $167.05 |