- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.78 / $79.03 / $100.57
| Professional | | $56.78 | $79.03 | $100.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.00 / $58.82 / $107.23
| Professional | | $31.00 | $58.82 | $107.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.58 / $82.41 / $126.46
| Professional | | $50.58 | $82.41 | $126.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.34 / $82.22 / $493.60
| Professional | | $38.34 | $82.22 | $493.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.77 / $79.94 / $151.74
| Professional | | $42.77 | $79.94 | $151.74 |