- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.52 / $88.70 / $119.06
| Professional | | $66.52 | $88.70 | $119.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.31 / $79.05 / $101.46
| Professional | | $57.31 | $79.05 | $101.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.00 / $98.00 / $177.37
| Professional | | $70.00 | $98.00 | $177.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.40 / $158.28 / $660.93
| Professional | | $92.40 | $158.28 | $660.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.35 / $106.93 / $196.68
| Professional | | $88.35 | $106.93 | $196.68 |