- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.35 / $48.27 / $84.72
| Professional | | $31.35 | $48.27 | $84.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.20 / $42.32 / $63.57
| Professional | | $33.20 | $42.32 | $63.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.95 / $60.28 / $106.49
| Professional | | $37.95 | $60.28 | $106.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.15 / $78.17 / $406.08
| Professional | | $51.15 | $78.17 | $406.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.07 / $65.75 / $109.46
| Professional | | $48.07 | $65.75 | $109.46 |