- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.64 / $77.22 / $140.59
| Professional | | $65.64 | $77.22 | $140.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.26 / $83.25 / $104.79
| Professional | | $70.26 | $83.25 | $104.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.85 / $57.96 / $75.44
| Professional | | $45.85 | $57.96 | $75.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.80 / $87.34 / $93.36
| Professional | | $78.80 | $87.34 | $93.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.97 / $69.48 / $100.00
| Professional | | $55.97 | $69.48 | $100.00 |