- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $56.08 / $75.09
| Professional | | $50.12 | $56.08 | $75.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.54 / $67.37 / $102.88
| Professional | | $56.54 | $67.37 | $102.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.73 / $61.32 / $75.03
| Professional | | $47.73 | $61.32 | $75.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.82 / $83.58 / $114.73
| Professional | | $61.82 | $83.58 | $114.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.40 / $59.14 / $90.06
| Professional | | $47.40 | $59.14 | $90.06 |