- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.68 / $79.62 / $90.05
| Professional | | $69.68 | $79.62 | $90.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.73 / $59.67 / $248.37
| Professional | | $52.73 | $59.67 | $248.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.64 / $104.42 / $211.70
| Professional | | $62.64 | $104.42 | $211.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.43 / $101.49 / $193.80
| Professional | | $78.43 | $101.49 | $193.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.31 / $102.34 / $205.28
| Professional | | $69.31 | $102.34 | $205.28 |