- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.65 / $58.45 / $78.54
| Professional | | $55.65 | $58.45 | $78.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.10 / $76.04 / $823.00
| Professional | | $52.10 | $76.04 | $823.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.59 / $73.67 / $204.36
| Professional | | $49.59 | $73.67 | $204.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.36 / $105.90 / $142.19
| Professional | | $68.36 | $105.90 | $142.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.94 / $58.61 / $175.82
| Professional | | $49.94 | $58.61 | $175.82 |