- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.46 / $67.55 / $104.53
| Professional | | $56.46 | $67.55 | $104.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.96 / $74.83 / $104.56
| Professional | | $48.96 | $74.83 | $104.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.74 / $60.00 / $75.03
| Professional | | $46.74 | $60.00 | $75.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.43 / $87.42 / $127.92
| Professional | | $65.43 | $87.42 | $127.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.40 / $64.26 / $97.02
| Professional | | $53.40 | $64.26 | $97.02 |