- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.13 / $53.73 / $64.79
| Professional | | $45.13 | $53.73 | $64.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.10 / $71.20 / $124.14
| Professional | | $53.10 | $71.20 | $124.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.27 / $77.63 / $110.08
| Professional | | $57.27 | $77.63 | $110.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.76 / $60.51 / $96.01
| Professional | | $45.76 | $60.51 | $96.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.89 / $56.88 / $107.81
| Professional | | $39.89 | $56.88 | $107.81 |