- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.14 / $71.93 / $162.47
| Professional | | $52.14 | $71.93 | $162.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.64 / $74.64 / $74.64
| Professional | | $74.64 | $74.64 | $74.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.88 / $83.24 / $111.40
| Professional | | $43.88 | $83.24 | $111.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.65 / $66.56 / $446.85
| Professional | | $34.65 | $66.56 | $446.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.75 / $69.72 / $103.31
| Professional | | $35.75 | $69.72 | $103.31 |