- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.08 / $47.23 / $67.73
| Professional | | $43.08 | $47.23 | $67.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.80 / $69.70 / $119.39
| Professional | | $42.80 | $69.70 | $119.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.40 / $62.58 / $113.03
| Professional | | $41.40 | $62.58 | $113.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.86 / $351.86 / $458.10
| Professional | | $351.86 | $351.86 | $458.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.44 / $59.16 / $104.73
| Professional | | $44.44 | $59.16 | $104.73 |